颈内静脉血栓对颅内循环系统影响的实验研究

doi:10.3877/cma.j.issn.2095-123X.2022.03.002

目的

探讨颈内静脉血栓对颅内循环系统的影响。

方法

选用日本大耳兔40只，随机分为左侧颈内静脉血栓组（左侧组）、右侧颈内静脉血栓组（右侧组）、双侧颈内静脉血栓组（双侧组）和假手术组，每组10只。通过阻断血流、损伤血内膜并注入凝血酶建立血栓模型。行颈部彩超检查确认血栓模型建立成功，并测量血栓前后健侧颈内静脉直径。经TCD监测72 h内大脑前动脉血流速度变化。术后1周行全脑血管造影，观察颅内静脉流出通道变化，处死后取患侧额叶脑组织做HE染色观察病理改变。

结果

与假手术组比较，左、右侧组术后即刻大脑前动脉血流速度加快（P<0.05），24 h达到最快（P<0.05），48 h恢复到正常水平（P>0.05），DSA显示健侧颈内静脉是颅内静脉血主要流出通道；双侧组血栓后大脑前动脉血流速度明显加快（P<0.05），同样在24 h达到最快（P<0.05），术后72 h时仍高于术前水平（P<0.05），DSA提示椎静脉丛作为隐藏的代偿通道开始显影；假手术组术前与术后各时间点大脑前动脉血流速度比较，差异均无统计学意义（P>0.05）。

结论

颈内静脉血栓对颅内动脉和静脉循环均有影响，可导致颅内静脉回流不畅，大脑前动脉血流速度会代偿性加快。

关键词: 颈内静脉, 血栓, 血流速度

Objective

To investigate the effects of internal jugular vein thrombosis on intracranial circulation system.

Methods

Forty Japanese white rabbits were divided into left jugular vein thrombosis group (left group), right jugular vein thrombosis group (right group), bilateral jugular vein thrombosis group (bilateral group) and sham group randomly. Ten rabbits were in each group. The thrombus model was established by blocking blood flow, damaging the intima and injecting thrombin. The model was established successfully by cervical color Doppler ultrasonography. Internal jugular vein diameter of the affected side was measured before and after thrombosis. Flow velocity of the anterior cerebral artery was measured by transcranial Doppler within 72 h postoperatively. One week after the operation, cerebral angiography was performed to observe the changes of intracranial venous outflow pathway. The frontal lobe tissues of the affected side were taken for HE staining to observe the pathological changes after the death.

Results

Compared with the sham group, the anterior cerebral artery flow velocity was increased immediately after operation (P<0.05) and reached maximum at 24 h (P<0.05), then decreased to normal level at 48 h (P>0.05) in left and right group. DSA showed that the healthy internal jugular vein was the main outflow channel of intracranial venous blood. Flow velocity of the anterior cerebral artery increased remarkablely (P<0.05) and reached peak at 24 h (P<0.05), then decreased slowly, and keeping high level at 72 h (P<0.05) in bilateral group. DSA suggested that the vertebral venous plexus began to develop as a hidden compensatory channel. Compared with pre-operation, there was no significant difference in anterior cerebral artery flow velocity at each time point in the sham group (P>0.05).

Conclusion

Internal jugular vein thrombosis affects both intracranial artery and venous circulation. It can lead to poor intracranial venous return and compensatory acceleration of anterior cerebral artery blood flow velocity.

Key words: Internal jugular vein, Thrombosis, Blood flow velocity

图1 兔颈内静脉手术前后彩超图像 A：术前蓝色颈内静脉血流（箭头所示）；B：术后颈内静脉血栓形成（箭头所示）

表1 颈内静脉直径改变(mm，Mean±SD)

组别	只数	术前	术后	t值	P值
假手术组	10	0.92±0.19	0.93±0.11	-0.142	0.891
左侧组	10	0.94±0.20	1.15±0.12^a	-3.280	0.010
右侧组	10	0.84±0.16	1.14±0.20^a	-3.182	0.011
双侧组	10	0.88±0.15	1.34±0.18^abc	-6.406	<0.001
F值		0.632	11.561
P值		0.599	<0.001

表1 颈内静脉直径改变(mm，Mean±SD)

组别	只数	术前	术后	t值	P值
假手术组	10	0.92±0.19	0.93±0.11	-0.142	0.891
左侧组	10	0.94±0.20	1.15±0.12^a	-3.280	0.010
右侧组	10	0.84±0.16	1.14±0.20^a	-3.182	0.011
双侧组	10	0.88±0.15	1.34±0.18^abc	-6.406	<0.001
F值		0.632	11.561
P值		0.599	<0.001

图2 双侧组大脑前动脉TCD频谱变化 A：术前大脑前动脉收缩峰呈近似直角三角形，间距均匀；B：术后12 h收缩峰高尖，并随着呼吸波动，血流阻力增大，血流频率加快；C：术后24 h收缩峰高尖，并出现"第二收缩峰"（箭头所示），血流阻力更大，血流速度更快；D：术后72 h收缩峰稍高，血流速度较快

表2 大脑前动脉血流速度变化(cm/s，Mean±SD)

组别	只数	术前	术后0 h	术后12 h	术后24 h	术后48 h	术后72 h	F值	P值
假手术组	10	20.09±3.12	21.15±2.93	20.72±3.89	20.32±3.98	20.10±3.69	20.30±3.53	0.151	0.979
左侧组	10	20.24±3.59	22.35±5.63	27.26±4.17^ab	28.42±3.72^ab	21.58±6.00	20.83±2.68	6.471	<0.001
右侧组	10	20.29±2.72	24.02±5.12	28.50±4.40^ab	29.09±5.29^ab	21.56±3.37	20.80±3.80	8.642	<0.001
双侧组	10	20.49±3.29	25.37±4.73	29.94±4.38^ab	33.88±3.41^abcd	26.79±4.64^abcd	26.53±2.67^abcd	13.537	<0.001
F值		0.027	1.542	9.331	18.271	4.190	8.476
P值		0.994	0.220	<0.001	<0.001	0.012	<0.001

表2 大脑前动脉血流速度变化(cm/s，Mean±SD)

组别	只数	术前	术后0 h	术后12 h	术后24 h	术后48 h	术后72 h	F值	P值
假手术组	10	20.09±3.12	21.15±2.93	20.72±3.89	20.32±3.98	20.10±3.69	20.30±3.53	0.151	0.979
左侧组	10	20.24±3.59	22.35±5.63	27.26±4.17^ab	28.42±3.72^ab	21.58±6.00	20.83±2.68	6.471	<0.001
右侧组	10	20.29±2.72	24.02±5.12	28.50±4.40^ab	29.09±5.29^ab	21.56±3.37	20.80±3.80	8.642	<0.001
双侧组	10	20.49±3.29	25.37±4.73	29.94±4.38^ab	33.88±3.41^abcd	26.79±4.64^abcd	26.53±2.67^abcd	13.537	<0.001
F值		0.027	1.542	9.331	18.271	4.190	8.476
P值		0.994	0.220	<0.001	<0.001	0.012	<0.001

图3 术后1周脑血管造影静脉期表现 A：左侧颈内静脉血栓组，右侧颈内静脉为静脉血出颅主要通道（箭头所示）；B：右侧颈内静脉血栓组，左侧颈内静脉为静脉血出颅主要通道（箭头所示）；C：双侧颈内静脉血栓组，椎静脉丛为静脉血出颅主要通道（箭头所示）；D：假手术组可见双侧颈内静脉回流（箭头所示）

图4 术后1周脑组织形态学表现（HE，×100） A：胶质细胞"嗜神经"现象（箭头所示）；B：脑血管内血栓形成（箭头所示）；C：血栓周围淋巴细胞浸润，"血管套"形成（箭头所示）；D：神经元排列整齐、染色均匀

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Experimental study on intracranial circulatory system of internal jugular vein thrombosis

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Experimental study on intracranial circulatory system of internal jugular vein thrombosis