脑蛛网膜下腔出血课件

SubarachnoidHemorrhage

CausesMicrocirculationDeficit：

anin-vivomicroscopystudy

ChenNishan/

陈妮姗脑蛛网膜下腔出血OutlineIntroduction;Researchpurposes;Materialandmethod;ResultandDiscussion;Evaluationandoutlook;Conclusion.脑蛛网膜下腔出血ReferencesCahillWJ,CalvertJH,ZHangJH,etal.Mechanismsofearlybraininjuryaftersubarachnoidhemorrhage[J].JCerebBloodFlowMetab,2006,26(11):1341-1353E.Koniewska,R.Michaliketal.Mechanismsofvasculardysfunctionaftersubarachnoidhemorrhage[J].J.PhysiologyandPharmacology,2006,57,11,145.160WestermAierT,Jaussa,EriskatJ,etal.Time-courseofcerebralperfusionandtissueoxygenationinthefirst6hafterexperimentalsubarachnoidhemorrhageinrats[J].JCerebBloodFlowMetab,2009,29(4):771-779BenjaminFriedrich,etal.Experimentalsubarachnoidhemorrhagecausesearlyandlong-lastingmicroarterialconstrictionandmicrothrombosis:anin-vivomicroscopystudy.JCerebFlow

Metab.2012,32(3):447-455IshikawaMami;KusakaGen;YamaguchiNoriyuki.Plateletandleukocyteadhesioninthemicrovasculartureatthecerebralsurfaceimmediatelyaftersubarachnoidhemorrhage,J.Neurosurgery,2009,64(3):546-553DanielZ,MuhammadF.etal.Delayedischemiaaftersubarachnoidhemorrhage:resultofvasospasmaloneorabroader[J],J.VascMed200712:243脑蛛网膜下腔出血IntroductionSubarachnoidHemorrhage(SAH):Asubtypeofstrokewithaparticularlyhighmorbidityandmortality.EarlyBrainInjury(EBI):Occurswithin72haftertheinitialbleed;Noeffectivetreatmentisavailable;Mechanismshaverecentlystartedtobeunderstood.脑蛛网膜下腔出血CAHILLWJ,CALVERTJH,ZHANGJH,etal.Mechanismsofearlybraininjuryaftersubarachnoidhemorrhage[J].JCerebBloodFlowMetab,2006,26(11):1341-1353脑蛛网膜下腔出血E.KONIEWSKA,R.MICHALIKetal.MECHANISMSOFVASCULARDYSFUNCTIONAFTER

SUBARACHNOIDHEMORRHAGE[J]J.PHYSIOLOGYANDPHARMACOLOGY2006,57,Suppl11,145.160脑蛛网膜下腔出血WESTERMAIERT,JAUSSA,ERISKATJ,etal.Time-courseofcerebralperfusionandtissueoxygenationinthefirst6hafterexperimentalsubarachnoidhemorrhageinrats[J].JCerebBloodFlowMetab,2009,29(4):771-779脑蛛网膜下腔出血ResearchpurposesCPPindependentInvestigateinvivoAlterationson

microcirculation?Whether/When/Where/What/HowRelationshipwithmicrothrombiEarlyperfusiondeficits

CBFreduction脑蛛网膜下腔出血MaterialandMethod

CWpmodel;Cranialwindow;Intravitalfluorescencemicroscopy.

脑蛛网膜下腔出血MicrovascularConstriction:Numerousconstricted

arterioleswereobserved,incontracttovenules;Distributionofseveritychangedovertime.Result-1BenjaminFriedrich,etal.Experimentalsubarachnoidhemorrhagecausesearlyandlong-lastingmicroarterialconstrictionandmicrothrombosis:anin-vivomicroscopystudy.JCerebFlowMetab.2012,32(3):447-455脑蛛网膜下腔出血Result1MicrovascularConstriction:Numerousconstricted

arterioleswereobserved,incontracttovenules;Distributionofseveritychangedovertime.Thesmallestarteriolesaremostseverelyaffectedbymicrovasospasm.BenjaminFriedrich,etal.Experimentalsubarachnoidhemorrhagecausesearlyandlong-lastingmicroarterialconstrictionandmicrothrombosis:anin-vivomicroscopystudy.JCerebFlowMetab.2012,32(3):447-455脑蛛网膜下腔出血Result-1Microthrombi:Arteriolarconstrictionsoccurfirstandthentriggermicrothrombosis;

Theseverityofconstrictionwaspositivelycorrelatedwiththefrequencyofmicro-thrombiBenjaminFriedrich,etal.Experimentalsubarachnoidhemorrhagecausesearlyandlong-lastingmicroarterialconstrictionandmicrothrombosis:anin-vivomicroscopystudy.JCerebFlowMetab.2012,32(3):447-455脑蛛网膜下腔出血SummaryLong-lastinghemodynamicalterationsatthemicrocirculatorylevelmaybeanimportantmechanismforthedevelopmentofearlyposthemorrhagicischemia.

脑蛛网膜下腔出血P-selectinandApocyninP-selectin

Platelet-Leukocyte

rollingandadhesionEndothelial–LeukocyteadhesionPlatelet-Endothelialadhesionnon-P-selectin60%40%blockerPlatelet

P-selectinEndothelial

P-selectinLeukocyte

PSGL-1NAD(P)Hoxidase

Apocynin脑蛛网膜下腔出血Result-2Platelet-leukocyte-endothelialcellinteractionswereobservedmainlyinthepostcapillaryvenulesimmediatelyafterSAH.TreatmentwithP-selectin-blockingantibodybeforeSAHreducedrollingandadherentplateletsalmosttobaselinelevels.Treatmentwithapocynin

beforeSAHreducedplateletadhesionbyonehalf.IshikawaMami;KusakaGen;YamaguchiNoriyuki.Plateletandleukocyteadhesioninthemicrovasculartureatthecerebralsurfaceimmediatelyaftersubarachnoidhemorrhage,J.Neurosurgery,2009脑蛛网膜下腔出血DiscussionP-selectin

Platelet-Leukocyte

rollingandadhesionEndothelial–LeukocyteadhesionPlatelet-Endothelialadhesionnon-P-selectin60%40%blockerPlatelet

P-selectin;Endothelial

P-selectinLeukocyte

PSGL-1NAD(P)Hoxidase

ApocyninApocynin脑蛛网膜下腔出血SummaryP-selectinandNAD(P)HoxidaseparticipateintheearlymicrovascularresponsestoSAH.脑蛛网膜下腔出血EvaluationAdvantages:ProvideMorphologicalevidence;Helpverifymechanisms;Invivo;Dynamicchangesatearlytime;Microcirculation;Retainedduramater;Limitations:superficialstructuresonly;decompressioncraniectomy;detailedmolecularmechanisms;脑蛛网膜下腔出血OutlookThedistincteventsoccurinmicro-arteriolesandmicro-venules?whichpathwaysplayadominantrole?Otherpotentialrolesintheinductionofmicrocirculationdeficit?Combinewithmolecularbiologystudy?Secret