脑蛛网膜下腔出血.pptx

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,#,脑蛛网膜下腔出血,脑蛛网膜下腔出血,第1页,Outline,Introduction;,Research purposes;,Material and method;,Result and Discussion;,Evaluation and outlook;,Conclusion.,脑蛛网膜下腔出血,第2页,References,Cahill W J,Calvert J H,Z Hang JH,et al.Mechanisms of early brain injury after subarachnoid hemorrhage J .,J Cereb Blood Flow Metab,26(11):1341-1353,E.Koniewska,R.Michalik et al.Mechanisms of vascular dysfunction after subarachnoid hemorrhage J.,J.Physiology and Pharmacology,57,11,145.160,Westerm Aier T,Jauss a,Eriskat J,et al.Time-course of cerebral perfusion and tissue oxygenation in the first 6 h after experimental subarachnoid hemorrhage in rats J .,J Cereb Blood Flow Metab,29(4):771-779,Benjamin Friedrich,et al.Experimental subarachnoid hemorrhage causes early and long-lasting microarterial constriction and microthrombosis:an in-vivo microscopy study.,J C ereb Flow,Metab,.,32(3):447-455,Ishikawa Mami;Kusaka Gen;Yamaguchi Noriyuki.Platelet and leukocyte adhesion in the microvascularture at the cerebral surface immediately after subarachnoid hemorrhage,J.Neurosurgery,64(3):546-553,Daniel Z,Muhammad F.et al.Delayed ischemia after subarachnoid hemorrhage:result of vasospasm alone or a broader J,J.Vasc Med 12:243,脑蛛网膜下腔出血,第3页,Introduction,Subarachnoid Hemorrhage(SAH):,A subtype of stroke with a particularly high morbidity and mortality.,Early Brain Injury(EBI):,Occurs within 72h after,the initial bleed;,No effective treatment is available;,Mechanisms have recently started to be understood.,脑蛛网膜下腔出血,第4页,CAHILL W J,CALVERT J H,Z HANG JH,et al.Mechanisms of early brain injury after subarachnoid hemorrhage J .J CerebBlood Flow Metab,26(11):1341-1353,脑蛛网膜下腔出血,第5页,E.KONIEWSKA,R.MICHALIK et al.MECHANISMS OF VASCULAR DYSFUNCTION AFTER SUBARACHNOID HEMORRHAGE JJ.PHYSIOLOGY AND PHARMACOLOGY,57,Suppl 11,145.160,脑蛛网膜下腔出血,第6页,WESTERM AIER T,JAUSS A,ERISKAT J,et al.Time-course of cerebral perfusion and tissue oxygenation in the first 6 h after experimental subarachnoid hemorrhage in rats J .J Cereb Blood Flow Metab,29(4):771-779,脑蛛网膜下腔出血,第7页,Research purposes,CPP,independent,Investigate,in vivo,Alterations on,microcirculation?,Whether/When/,Where/What/How,Relationship with,microthrombi,Early perfusion,deficits,CBF,reduction,脑蛛网膜下腔出血,第8页,Material and Method,CWp model;,Cranial window;,Intravital fluorescence microscopy.,脑蛛网膜下腔出血,第9页,Microvascular Constriction:,Numerous constricted,arterioles,were observed,in contract to venules;,Distribution of,severity,changed over,time,.,Result-1,Benjamin Friedrich,et al.Experimental subarachnoid hemorrhage causes early and long-lasting microarterial constriction and microthrombosis:an in-vivo microscopy study.J C ereb Flow Metab.,32(3):447-455,脑蛛网膜下腔出血,第10页,Result 1,Microvascular Constriction:,Numerous constricted,arterioles,were observed,in contract to venules;,Distribution of,severity,changed over,time,.,The,smallest,arterioles are,most severely,affected by microvasospasm.,Benjamin Friedrich,et al.Experimental subarachnoid hemorrhage causes early and long-lasting microarterial constriction and microthrombosis:an in-vivo microscopy study.J C ereb Flow Metab.,32(3):447-455,脑蛛网膜下腔出血,第11页,Result-1,Microthrombi:,Arteriolar constrictions occur first and,then trigger,microthrombosis;,The severity of constriction was,positively correlated with,the frequency of micro-thrombi,Benjamin Friedrich,et al.Experimental subarachnoid hemorrhage causes early and long-lasting microarterial constriction and microthrombosis:an in-vivo microscopy study.J C ereb Flow Metab.,32(3):447-455,脑蛛网膜下腔出血,第12页,Summary,Long-lasting hemodynamic alterations at the microcirculatory level may be an important mechanism for the development of early post hemorrhagic ischemia.,脑蛛网膜下腔出血,第13页,P-selectin and Apocynin,P-selectin,Platelet,-,Leukocyte,rolling and adhesion,Endothelial,Leukocyte,adhesion,Platelet,-,Endothelial,adhesion,non-,P-selectin,60%,40%,blocker,Platelet,P-selectin,Endothelial,P-selectin,Leukocyte,PSGL-1,NAD(P)H,oxidase,Apocynin,脑蛛网膜下腔出血,第14页,Result-2,Platelet-leukocyte-endothelial cell interactions were observed mainly in the postcapillary,venules,immediately after SAH.,Treatment with,P-selectin-blocking,antibody,before SAH reduced,rolling and adherent platelets,almost to,baseline,levels.,Treatment with,apocynin,before SAH reduced,platelet adhesion,by,one half,.,Ishikawa Mami;Kusaka Gen;Yamaguchi Noriyuki.Platelet and leukocyte adhesion in the microvascularture at the cerebral surface immediately after subarachnoid hemorrhage,J.Neurosurgery,脑蛛网膜下腔出血,第15页,Discussion,P-selectin,Platelet,-,Leukocyte,rolling and adhesion,Endothelial,Leukocyte,adhesion,Platelet,-,Endothelial,adhesion,non-,P-selectin,60%,40%,blocker,Platelet,P-selectin;,Endothelial,P-selectin,Leukocyte,PSGL-1,NAD(P)H,oxidase,Apocynin,Apocynin,脑蛛网膜下腔出血,第16页,Summary,P-selectin and NAD(P)H oxidase participate in the early microvascular responses to SAH.,脑蛛网膜下腔出血,第17页,Evaluation,Advantages:,Provide Morphological evidence;,Help verify mechanisms;,In vivo;,Dynamic changes at early time;,Microcirculation;,Retained dura mater;,Limitations:,superficial structures only;,decompression craniectomy;,detailed molecular mechanisms;,脑蛛网膜下腔出血,第18页,Outlook,The distinct events occur in micro-arterioles and micro-venules?,which pathways play a dominant role?,Other potential roles in the induction of microcirculation deficit?,Combine with molecular biology study?,Secret hidden behind the phenomenon.,Daniel Z,Muhammad F.et al.Delayed ischemia after subarachnoid hemorrhage:result of vasospasm alone or a broader J,J.Vasc Med 12:243,脑蛛网膜下腔出血,第19页,Conclusion,In-vivo fluorescence microscopy study plays an important role in observing morphological changes as well as cell-interactions at the microcirculatory level at early time after SAH.,It might be used in a broader and deeper field combining with molecular biology study,creating an effective way to understand microcirculation deficit caused by SAH,thus help us to reduce the mortality of EBI.,脑蛛网膜下腔出血,第20页,