ROLE OF THE DUCTUS THORACICUS IN PULMONARY FAT EMBOLISM AFTER SUBARACHNOID HAEMORRHAGE: A PRELIMINARY EXPERIMENTAL STUDY

Öz

Objective: Subarachnoid haemorrhage is a multisystemic disease due to its effects on the autonomic nervous system. Pulmonary tissues may be affected due to its effects on the intestinal system, lipid metabolism, and ductus thoracicus in subarachnoid haemorrhage. This study demonstrate the pathophysiology of pulmonary fat embolism after sympathetic activation of the ductus thoracicus with lipid absorption disorders after subarachnoid haemorrhage. Material and Methods: In the study, 24 male rabbits were used, of which five were selected as the control group (GI) and five as the SHAM group (GII). The SHAM group was injected with a 0.7 mL isotonic solution into the cisterna magna. The study group (GIII) was injected with 0.7 mL autologous blood into the cisterna magna. The lymphatic vessels in the middle sections of the duodenum, the thoracic duct portions opening into the jugular vein, and the terminal branches of the pulmonary arteries were examined and counted. Results: The thoracic duct vasospasm index (VSI) values and numbers of branches occluded by fat particles in the pulmonary arteries were: 1.65±0.22/3.21±0.54 in GI, 1.97±0.34/7.3±2.4 in GII, and 2.54±0.56/14.53±14.53 in GIII. In the six subjects with severe thoracic duct spasm in GIII, the number of pulmonary arteries occluded with chylomicrons was higher (p>0.00001). P values among groups were: p> 0.05 in GI/GII; p<0.005 in GII/GIII and p<0.0001 in GI/GIII. Conclusion: This is the first experimental study conducted on animals investigating the lipid metabolism disorder associated with subarachnoid haemorrhage affecting the cervical ganglia, thoracic duct spasm, and pulmonary fat embolism.

Anahtar Kelimeler

• Subarachnoid haemorrhage
• thoracic duct
• chylomicrons
• pulmonary fat embolism

SUBARAKNOİD KANAMA SONRASI GELİŞEN PULMONER YAĞ EMBOLİSİNDE DUCTUS THORACICUS'UN ROLÜ: ÖN DENEYSEL ÇALIŞMA

Öz

Amaç: Subaraknoid kanama, otonom sinir sistemi üzerindeki etkileri nedeniyle multisistemik bir hastalıktır. Subaraknoid kanamada intestinal sistem, lipid metabolizması ve duktus torasikus üzerindeki etkileri nedeniyle pulmoner dokular etkilenebilir. Bu çalışma, subaraknoid kanamadan sonra lipid emilim bozuklukları ile birlikte duktus torasikusun sempatik aktivasyonundan sonra pulmoner yağ embolisinin patofizyolojisini göstermeyi amaçlamıştır. Gereç ve Yöntem: Çalışmada kullanılan 24 erkek tavşandan beşi kontrol grubu (GI), beşi SHAM (GII) olarak seçildi ve SHAM grubunda sisterna magnaya 0,7 mL izotonik enjekte edildi. Çalışma grubunda (GIII) ise sisterna magnaya 0,7 mL otolog kan enjekte edildi. Deneklerin duodenum orta kısımlarındaki lenf damarları, juguler vene açılan torasik duktus kısımları ve pulmoner arterlerin terminal dalları incelendi ve sayıldı. Bulgular: Duktus torasikus vazospazm indeks (VSI) değerleri ve pulmoner arterlerde yağ parçacıkları tarafından tıkanan dal sayıları: GI'de 1,65±0,22/3,21±0,54, GII'de 1,97±0,34/7,3±2,4 ve GIII'te 2,54±0,56/14,53±14,53 idi. GIII'te şiddetli duktus torasikus spazmı olan altı denekte, şilomikronlarla tıkanmış pulmoner arter sayısı daha yüksekti (p>0,00001). Gruplar arasındaki p değerleri: GI/ GII'de p>0,05; GII/GIII'te p<0,005 ve GI/GIII'te p<0,0001 idi. Sonuç: Çalışmamız; subaraknoid kanama sonrası gelişen lipid metabolizması bozukluğunun, servikal ganglionlar, duktus torasikus spazmı ve pulmoner yağ embolisi ile ilişkisini araştıran ilk deneysel çalışmadır.

Anahtar Kelimeler

• Subaraknoid kanama
• torasik duktus
• şilomikronlar
• pulmoner yağ embolisi

Kaynakça

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