Nitic Oxide And Endothelin Concentration With Cerebral Vasospasm In Severe Traumatic Brain Injuery Patient

Objective:Cerebral vasospasm is one of the basic pathological changes of traumatic brain injury. In the brain, there are two important neurotransmitters:endothelin(ET)and nitric oxide (NO),which are likely the main materials triggering the Cerebral vasospasm(CVS). At present, the current researches on the role of ET and NO in nervous system are mainly focused on the spontaneous subarachnoid hemorrhage and cerebral ischemia, while there are less basic and clinical researches on the role of ET and NO in traumatic brain injury at home and aboard. This paper elucidates the relationships between vasospasm and the changing level over the time of the NO and ET in cerebrospinal fluid after severe traumatic brain injury.Methods:Analyze68cases of severe traumatic brain injury patients, with GCS <8points on admission. When the patients admitted to hospital for24h,3days,5days,7days, and10days, detect the blood flow velocity of the bilateral middle cerebral artery, internal carotid artery and extra-cranial cerebral blood flow.And at the same time, collect the cerebrospinal fluid specimens and measure the ET content in cerebrospinal fluid by radioimmunoassay and NO content in cerebrospinal fluid by nitrate reductase method. According to the results of transcranial doppler (TCD), the68patients are divided into cerebral vasospasm group and non-cerebral vasospasm group,together with the statistical analysis on the measured value.Based on the degree of cerebral vasospasm, the patients are divided into the light cerebral vasospasm group, the severe cerebral vasospasm group and non-cerebral vasospasm group and do the statistical analysis on the measured values of the three groups’ET and NO data in comparing with normal control group.Results:To the68patients, the54.4percent of them (37cases) has the disease of cerebral vasospasm:16cases of severe cerebral vascular spasm,11cases of moderate cerebral vasospasm and10cases of mild cerebral vasospasm. The tests show that after severe traumatic brain injury, the patients’ET levels in the cerebrospinal fluid are increased, while NO level was obviously decreased.The change of endothelin and NO level in cerebral vasospasm group is coincided with the examination results of transcranial doppler (TCD) in timing notes. The ET content in CSF in CVS groups continuously increases after injury and reaches the peak at the3rd day and after that it will maintain on a high level, which is remarkable different from non-CVS group(P<0.05). Besides that, the ET content in severe CVS group was obviously higher than it in moderate CVS groups (P<0.01). The NO content in CSF in CVS groups is lower than the control group and there exists the significant differences between them. But the NO content in CSF in non-CVS group is remarkably different from the control group (P<0.05) at the3rd and the5th day. The NO content in CFS in CVS group continuously decreases after injury and at the3rd day decreases most obviously, and then increases gradually. Also after injury, there is a remarkable difference about the NO content in CVS groups and non-CVS group. And the NO content in severe CVS group in3days later is significantly lower than that in light and moderate CVS group after injury.Conclusion:Severe traumatic brain injury often leads to the cerebral vasospasm, and the cerebral vasospasm usually is concerned with the increasing levels of endothelin and the decreasing levels of nitric oxide in cerebrospinal fluid. Meanwhile, the degree of cerebral vasospasm is coordinate with the changing of ET and NO in time aspects.