The Korean Journal of Pain

  • 제20권2호
  • /
  • Pages.83-91
  • /
  • 2007
  • /
  • 2005-9159(pISSN)
  • /
  • 2093-0569(eISSN)
대한통증학회 (The Korean Pain Society)
권호 표지
DOI QR코드

DOI QR Code

상경부교감신경절블록이 백서의 국소 뇌허혈/재관류로 인한 뇌 손상에 미치는 영향

Effect of Superior Cervical Sympathetic Ganglion Block on Brain Injury Induced by Focal Cerebral Ischemia/Reperfusion in a Rat Model

  • 이애령 (성균관대학교 의과대학 삼성서울병원 마취통증의학교실) ;
  • 윤미옥 (울산대학교 의과대학 서울아산병원 마취통증의학과) ;
  • 김현혜 (울산대학교 의과대학 서울아산병원 마취통증의학과) ;
  • 최재문 (울산대학교 의과대학 서울아산병원 마취통증의학과) ;
  • 전혜영 (울산대학교 의과대학 서울아산병원 마취통증의학과) ;
  • 신진우 (울산대학교 의과대학 서울아산병원 마취통증의학과) ;
  • 임정길 (울산대학교 의과대학 서울아산병원 마취통증의학과)
  • Lee, Ae Ryoung (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, College of Medicine) ;
  • Yoon, Mi Ok (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Hyun Hae (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Jae Moon (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jeon, Hae Yuong (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin, Jin Woo (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Leem, Jeong Gill (Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2007.07.20
  • 심사 : 2007.09.27
  • 발행 : 2007.12.10
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Cerebral blood vessels are innervated by sympathetic nerves that originate in the superior cervical ganglia (SCG). This study was conducted to determine the effect of an SCG block on brain injury caused by focal cerebral ischemia/reperfusion in a rat model. Methods: Male Sprague-Dawley rats (270-320 g) were randomly assigned to one of three groups (lidocaine, ropivacaine, and control). After brain injury induced by middle cerebral artery (MCA) occlusion/reperfusion, the animals were administered an SCG bloc that consisted of $30{\mu}l$ of 2% lidocaine or 0.75% ropivacaine, with the exception of animals in the control group, which received no treatment. Twenty four hours after brain injury was induced, neurologic scores were assessed and brain samples were collected. The infarct and edema ratios were measured, and DNA fragmented cells were counted in the frontoparietal cortex and the caudoputamen. Results: No significant differences in neurologic scores or edema ratios were observed among the three groups. However, the infarct ratio was significantly lower in the ropivacaine group than in the control group (P < 0.05), and the number of necrotic cells in the caudoputamen of the ropivacaine group was significantly lower than in the control group (P < 0.01). Additionally, the number of necrotic and apoptotic cells in theropivacaine group were significantly lower than inthe control group in both the caudoputamen and the frontoparietal cortex (P < 0.05). Conclusions: Brain injury induced by focal cerebral ischemia/reperfusion was reduced by an SCG block using local anesthetics. This finding suggests that a cervical sympathetic block could be considered as another treatment option for the treatment of cerebral vascular diseases.

키워드

과제정보

연구 과제 주관 기관 : 아산생명과학연구소

참고문헌

  1. Wang CX, Yang T, Shuaib A: An improved version of embolic model of brain ischemic injury in the rat. J Neurosci Methods 2001; 109: 147-51 https://doi.org/10.1016/S0165-0270(01)00408-3
  2. Mergenthaler P, Dimagl U, Meisel A: Pathophysiology of stroke: lessons from animal models, Metab Brain Dis 2004; 19: 151-67 https://doi.org/10.1023/B:MEBR.0000043966.46964.e6
  3. Haberg A, Qu H, Hjelstuen MH, Sonnewald U: Effect of the pyrrolopyrimidine lipid peroxidation inhibitor U-101033E on neuronal and astrocytic metabolism and infarct volume in rats with transient middle cerebral anery occlusion. Neurochem lnt 2007; 50: 932-40 https://doi.org/10.1016/j.neuint.2006.12.005
  4. Fan Y, Shi L, Gu Y, Zhao Y, Xie J, Qiao J, et al: Pretreatment with PTD-calbindin D 28k alleviates rat brain injury induced by ischemia and reperfusion. J Cereb Blood Flow Metab 2007; 27: 719-28 https://doi.org/10.1038/sj.jcbfm.9600373
  5. Treggiari MM, Romand JA, Marrin JB, Reverdin A, Rufenacht DA, de Ttibolet N: Cervical sympathetic block to reverse delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage. Stroke 2003; 34: 961-7 https://doi.org/10.1161/01.STR.0000060893.72098.80
  6. Elias M: Cervical sympathetic and stellate ganglion blocks. Pain Physician 2000; 3: 294-304
  7. Leos N, Grant DA, Wild J, Paul S, Barfield C, Zeccoli G, et al: Sympathetic nervous control of the cerebral circulation in sleep. J Sleep Res 2005; 14: 275-83 https://doi.org/10.1111/j.1365-2869.2005.00464.x
  8. Umeyama T, Kugimiya T, Ogawa T, Kandori Y, Ishizuka A, Hanaoka K: Changes in cerebral blood flow estimated after stellate ganglion block by single photon emission computed tomography. J Auton Nerv Syst 1995; 50: 339-46 https://doi.org/10.1016/0165-1838(94)00105-S
  9. Bederson JB, Pitts LH, Tsuji M, Nishimura MC, Davis RL, Bartkowski H: Rat middle cerebral artery occlusion: evaluation of the model and development of a neurologic examination. Stroke 1986; 17: 472-6 https://doi.org/10.1161/01.STR.17.3.472
  10. Memezawa H, Minamisawa H, Smith ML, Siesjo BK: Ischemic penumbra in a model of reversible middle cerebral artery occlusion in the rat. Exp Brain Res 1992; 89: 67-78
  11. Hossmann KA: Viability thresholds and the penumbra of focal ischemia. Ann Neurol 1994; 36: 557-65 https://doi.org/10.1002/ana.410360404
  12. Liu Y, Fiskum G, Schubert D: Generation of reactive oxygen species by the mitochondrial electron transport chain. J Neurochem 2002; 80: 780-7 https://doi.org/10.1046/j.0022-3042.2002.00744.x
  13. Piantadosi CA, Zhang J: Mitochondrial generation of reactive oxygen species after brain ischemia in the rat. Stroke 1996; 27: 327-31 https://doi.org/10.1161/01.STR.27.2.327
  14. Christophe M, Nicolas S: Mitochondria: a target for neuroprotective interventions in cerebral ischemia-reperfusion, Curr Pharm Des 2006; 12: 739-57 https://doi.org/10.2174/138161206775474242
  15. White BC, Sullivan JM, DeGracia DJ, O'Neil BJ, Neumar RW, Grossman LI, et al: Brain ischemia and reperfusion: molecular mechanisms of neuronal injury. J Neurol Sci 2000; 179: 1-33 https://doi.org/10.1016/S0022-510X(00)00386-5
  16. Murin R, Drgova A, Kaplan P, Dobrota D, Lehotsky J: Ischemia/Reperfusion-induced oxidative stress causes structural changes of brain membrane proteins and lipids. Gen Physiol Biophys 2001; 20: 431-8
  17. Tuor UI: Local distribution of the effects of sympathetic stimulation on cerebral blood flow in the rat. Brain Res 1990; 529: 224-31 https://doi.org/10.1016/0006-8993(90)90831-U
  18. Gupta MM, Bithal PK, Dash HH, Chaturvedi A, Mahajan RP: Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography. Br J Anaesth 2005; 95: 669-73 https://doi.org/10.1093/bja/aei230
  19. Hamel E: Perivascular nerves and the regulation of cerebrovascular tone. J Appl Physiol 2006; 100: 1059-64 https://doi.org/10.1152/japplphysiol.00954.2005
  20. Wagerle LC, Heffernan TM, Sacks LM, Delivoria-Papadopoulos M: Sympathetic effect on cerebral blood flow regulation in hypoxic newborn lambs. Am J Physiol 1983; 245: H487-94
  21. Busija DW, Heistad DD, Marcus ML: Effects of sympathetic nerves on cerebral vessels during acute, moderate increases in arterial pressure in dogs and cats. Circ Res 1980; 46: 696-702 https://doi.org/10.1161/01.RES.46.5.696
  22. Heistad DD, Marcus ML, Gross PM: Effects of sympathetic nerves on cerebral vessels in dog, cat, and monkey. Am J Physiol 1978; 235: H544-52
  23. Sadoshima S, Thames M, Heistad D: Cerebral blood flow during elevation of intracranial pressure: role of sympathetic nerves. Am J Physiol 1981; 241: H78-84
  24. Nitahara K, Dan K: Blood flow velocity changes in carotid and vertebral arteries with stellate ganglion block: measurement by magnetic resonance imaging using a direct bolus tracking method. Reg Anesth Pain Med 1998; 23: 600-4
  25. Park CH, Lee DS, Kim BI: Effect of the oblique fluoroscopic approach for performing stellate ganglion block. Korean J Pain 2006; 19: 68-71 https://doi.org/10.3344/kjp.2006.19.1.68
  26. Floyd JB Jr: Traumatic cerebral edema relieved by stellate ganglion anesthesia. South Med J 1987; 80: 1328 https://doi.org/10.1097/00007611-198710000-00035
  27. Takano M, Takano Y, Sato I: Unexpected beneficial effect of stellate ganglion block in a schizophrenic patient. Can J Anaesth 2002; 49: 758-9
  28. Gotoh F, Fukuuchi Y, Amano T, Tanaka K, Uematsu D, Suzuki N, et al: Comparison between pial and intraparenchymal vascular responses to cervical sympathetic stimulation in cats. Part 1. Under normal resting conditions. J Cereb Blood Flow Metab 1986; 6: 342-7 https://doi.org/10.1038/jcbfm.1986.58
  29. Yokoyama K, Kishida T, Sugiyama K: Stellate ganglion block and regional cerebral blood volume and oxygenation. Can J Anaesth 2004; 51: 515-6 https://doi.org/10.1007/BF03018319
  30. Moore DC: Stellate ganglion block-therapy for cerebral vascular accidents. Br J Anaesth 2006; 96: 666-7 https://doi.org/10.1093/bja/ael059
  31. Kirino T: Delayed neuronal death in the gerbil hippocampus following ischemia. Brain Res 1982; 239: 57-69 https://doi.org/10.1016/0006-8993(82)90833-2
  32. Johnson EM, Jr., Deckwerth TL: Molecular mechanisms of developmental neuronal death. Annu Rev Neurosci 1993; 16: 31-46 https://doi.org/10.1146/annurev.ne.16.030193.000335
  33. del Zoppo GJ, Mabuchi T: Cerebral microvessel responses to focal ischemia. J Cereb Blood Flow Metab 2003; 23: 879-94 https://doi.org/10.1097/01.WCB.0000078322.96027.78
  34. Okada Y, Copeland BR, Fitridge R, Koziol JA, del Zoppo GJ: Fibrin contributes to microvascular obstructions and parenchymal changes during early focal cerebral ischemia and reperfusion. Stroke 1994; 25: 1847-53 https://doi.org/10.1161/01.STR.25.9.1847
  35. Kamiya T, Katayama Y, Kashiwagi F, Terashi A: The role of bradykinin in mediating ischemic brain edema in rats. Stroke 1993; 24: 571-5 https://doi.org/10.1161/01.STR.24.4.571
  36. Abumiya T, Lucero J, Reo JR, Tagaya M, Koziol JA, Copeland BR, et al: Activated microvessels express vascular endothelial growth factor and integrin alpha(v)beta3 during focal cerebral ischemia. J Cereb Blood Flow Metab 1999; 19: 1038-50 https://doi.org/10.1097/00004647-199909000-00012
  37. Heo JR, Lucero J, Abumiya T, Koziol JA, Copeland BR, del Zoppo GJ: Matrix metalloproteinases increase very early during experimental focal cerebral ischemia. J Cereb Blood Flow Metab 1999; 19: 624-33 https://doi.org/10.1097/00004647-199906000-00005
  38. Hasty KA, Pourmotabbed TF, Goldberg or, Thompson JP, Spinella DG, Stevens RM, et al: Human neutrophil collagenase. A distinct gene product with homology to other matrix metalloproteinases. J Biol Chem 1990; 265: 11421-4
  39. Rogers DC, Campbell CA, Stretton JL, Mackay KB: Correlation between motor impairment and infarct volume after permanent and transient middle cerebral artery occlusion in the rat. Stroke 1997; 28: 2060-5 https://doi.org/10.1161/01.STR.28.10.2060
  40. Smith SE, Hodges H, Sowinski P, Man CM, Leach MJ, Sinden JD, et at: Long-term beneficial effects of BW619C89 on neurological deficit, cognitive deficit and brain damage after middle cerebral artery occlusion in the rat. Neuroscience 1997; 77: 1123-35 https://doi.org/10.1016/S0306-4522(96)00530-1
  41. Zausinger S, Hungerhuber E, Baethmann A, Reulen H, Schmid-Elsaesser R: Neurological impairment in rats after transient middle cerebral artery occlusion: a comparative study under various treatment paradigms. Brain Res 2000; 863: 94-105 https://doi.org/10.1016/S0006-8993(00)02100-4

피인용 문헌

  1. 상경부교감신경절블록은 백서의 영구국소뇌허혈에서 초기의 뇌손상에는 영향을 미치지 못한다 vol.21, pp.1, 2007, https://doi.org/10.3344/kjp.2008.21.1.33
  2. 백서의 국소 뇌허혈/재관류로 인한 신경손상에서 상경부 교감 신경절 블록의 급성기 및 장기 보호효과 vol.21, pp.2, 2008, https://doi.org/10.3344/kjp.2008.21.2.119