本文關(guān)鍵詞：護(hù)理干預(yù)對大鼠脊髓損傷后運(yùn)動功能修復(fù)的影響　出處：《第三軍醫(yī)大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 脊髓損傷 護(hù)理干預(yù) 大鼠 運(yùn)動功能

【摘要】：研究背景： 脊髓損傷(Spinal cord injury SCI)是中樞神經(jīng)系統(tǒng)(Central nervous system CNS)的嚴(yán)重?fù)p傷，SCI后往往導(dǎo)致較嚴(yán)重的神經(jīng)功能缺損。而運(yùn)動功能障礙是導(dǎo)致患者存活期喪失生活自理能力的最主要原因。SCI患者運(yùn)動功能修復(fù)一直是醫(yī)患雙方關(guān)注的焦點(diǎn)，而運(yùn)動功能訓(xùn)練是臨床脊髓損傷患者運(yùn)動功能康復(fù)的重要方法。已有的研究表明，脊髓損傷后臨床早期和持之以恒地進(jìn)行運(yùn)動功能護(hù)理干預(yù)可以促進(jìn)脊髓損傷患者運(yùn)動功能部分恢復(fù)，但其機(jī)制仍不十分清楚，尚需更多基礎(chǔ)研究資料作為支撐。因此，本研究對脊髓損傷后大鼠進(jìn)行運(yùn)動功能護(hù)理干預(yù)，利用BBB評分(Basso,Beattie and Bresnahanscore)和斜坡試驗(yàn)(Inclined-plane score IP Score)，肌電反應(yīng)和肌濕重檢測，常規(guī)蘇木精-伊紅(Hematoxiline-eosin HE)染色，免疫組織化學(xué)(Immunohistochemistry IHC)染色法等，評估了護(hù)理干預(yù)對脊髓損傷后大鼠雙后肢運(yùn)動功能變化，腓腸肌電反應(yīng)和肌濕重變化，光學(xué)顯微鏡觀察了脊髓損傷斷面的形態(tài)學(xué)變化，以期尋找護(hù)理干預(yù)在修復(fù)損傷脊髓的運(yùn)動功能中的作用和支撐證據(jù)。 目的： 觀察護(hù)理干預(yù)對大鼠脊髓損傷后脊髓運(yùn)動功能的恢復(fù)程度與變化，探討護(hù)理干預(yù)在修復(fù)損傷脊髓功能中的作用，為臨床護(hù)理提供循證依據(jù)。 材料和方法： 1.分組：將60只SD成年大鼠(約250g，雌雄不限)隨機(jī)分為A組為正常對照組，B組為實(shí)驗(yàn)對照組和C組為實(shí)驗(yàn)組三組(各組均為n=20)；B組和C組又分為脊髓損傷后1d、7d、30d、60d四個時相點(diǎn)(各個時相點(diǎn)均為n=5)。 2.方法： 2.1大鼠脊髓損傷模型制備B組和C組均采用切割加擠壓L4平面橫斷脊髓制備脊髓損傷大鼠模型。 2.2護(hù)理干預(yù)措施A組大鼠為正常對照組，B組大鼠脊髓損傷后給予常規(guī)護(hù)理，C組大鼠脊髓損傷后給予護(hù)理干預(yù)。B組和C組大鼠均于脊髓損傷后1d開始進(jìn)行腹腔注射青霉素鈉20萬U1次/d，連續(xù)注射3d以預(yù)防感染，協(xié)助受傷大鼠排尿、排便2次/d等常規(guī)護(hù)理；C組除常規(guī)護(hù)理之外，還給予按摩膀胱與腹部、關(guān)節(jié)活動度訓(xùn)練和肌肉按摩訓(xùn)練等被動運(yùn)動訓(xùn)練，護(hù)理干預(yù)均于損傷后立即進(jìn)行，以后為2次/d，10min/次/只大鼠。大鼠后肢進(jìn)行被動關(guān)節(jié)活動訓(xùn)練，具體包括膝被動屈伸、膝被動外展內(nèi)收，髖被動屈伸、髖被動外展內(nèi)收，踝被動背屈跖屈訓(xùn)練，以維持和改善其關(guān)節(jié)活動度；肌肉按壓訓(xùn)練主要以向心性和環(huán)形交替按摩足部、小腿、大腿各肌肉群以減少雙后肢水腫及增加血液循環(huán)。 2.3BBB評分和斜坡試驗(yàn)各組大鼠采用BBB評分法及斜坡試驗(yàn)進(jìn)行雙后肢運(yùn)動功能評分，分別于脊髓損傷后1d、7d、30d和60d四個相同時相點(diǎn)檢測，評估護(hù)理干預(yù)后大鼠脊髓損傷的行為學(xué)變化。 2.4肌電反應(yīng)和肌濕重檢測通過肌電反應(yīng)和肌濕重檢測，觀察大鼠脊髓損傷后1d、7d、30d和60d腓腸肌的肌電反應(yīng)和肌濕重變化，比較護(hù)理干預(yù)后大鼠脊髓損傷失神經(jīng)支配腓腸肌的萎縮程度。 2.5常規(guī)HE染色采用組織學(xué)切片行HE染色，以觀察各組各個時相點(diǎn)脊髓損傷大鼠的組織修復(fù)情況。 2.6免疫組織化學(xué)染色法采用免疫組織化學(xué)法染色顯示各組脊髓損傷大鼠各個時相點(diǎn)的神經(jīng)絲蛋白-200(Neurofilament-200NF-200)和膠質(zhì)纖維酸性蛋白(Glial fibrillaryacidic protein GFAP)的變化，觀察脊髓損傷后大鼠經(jīng)護(hù)理干預(yù)后在各組各時相點(diǎn)中神經(jīng)元的NF-200免疫反應(yīng)陽性變化和神經(jīng)膠質(zhì)細(xì)胞的GFAP免疫反應(yīng)陽性變化。 主要結(jié)果： 第一部分：護(hù)理干預(yù)對大鼠脊髓損傷后脊髓運(yùn)動功能修復(fù)的行為學(xué)影響 1.BBB評分和斜坡試驗(yàn)結(jié)果顯示，在脊髓損傷后1d和7d時相點(diǎn)，實(shí)驗(yàn)組與實(shí)驗(yàn)對照組相比較，護(hù)理干預(yù)后BBB評分和斜坡試驗(yàn)無明顯差異(P＞0.05)；在脊髓損傷后30d和60d時相點(diǎn)，實(shí)驗(yàn)組較實(shí)驗(yàn)對照組高(P＜0.05)，實(shí)驗(yàn)組大鼠后肢功能明顯改善，但實(shí)驗(yàn)組和實(shí)驗(yàn)對照組得分低于正常對照組，均未達(dá)到正常水平。 2.腓腸肌電反應(yīng)結(jié)果顯示，在脊髓損傷后30d和60d時相點(diǎn)，實(shí)驗(yàn)組和實(shí)驗(yàn)對照組出現(xiàn)肌纖顫電位，且實(shí)驗(yàn)組較實(shí)驗(yàn)對照組的腓腸肌纖顫電位波波幅增高(P＜0.05)，有統(tǒng)計(jì)學(xué)意義。 3.腓腸肌濕重稱量結(jié)果顯示，在脊髓損傷后60d時相點(diǎn)，實(shí)驗(yàn)組和實(shí)驗(yàn)對照組的腓腸肌濕重與正常對照組相比明顯減輕(P＜0.01)，實(shí)驗(yàn)對照組與實(shí)驗(yàn)組相比，實(shí)驗(yàn)組腓腸肌濕重下降較實(shí)驗(yàn)對照組輕(P＜0.05)，差異有統(tǒng)計(jì)學(xué)意義。 第二部分：護(hù)理干預(yù)對大鼠脊髓損傷后脊髓運(yùn)動功能修復(fù)的形態(tài)學(xué)影響 1. HE染色結(jié)果 脊髓損傷后1d，實(shí)驗(yàn)組和實(shí)驗(yàn)對照組HE染色在脊髓損傷區(qū)均可見出血現(xiàn)象和輕度炎性反應(yīng)，在損傷的腔隙內(nèi)可見組織碎片；脊髓損傷后7d，損傷區(qū)脊髓組織結(jié)構(gòu)紊亂，大量炎性細(xì)胞浸潤，炎性反應(yīng)加劇，也可見增生的各種細(xì)胞及增生的毛細(xì)血管，神經(jīng)元腫脹、壞死，突起消失；脊髓損傷后30d，實(shí)驗(yàn)組和實(shí)驗(yàn)對照組均可見脊髓損傷區(qū)炎性反應(yīng)減輕或消失，出現(xiàn)囊腔樣變化或空腔。組織填充處，細(xì)胞增生十分明顯，增生細(xì)胞有一定方向性，呈簇狀排列，增生的組織中見大量增生的毛細(xì)血管；脊髓損傷后60d，損傷部位脊髓組織結(jié)構(gòu)改善，實(shí)驗(yàn)組和實(shí)驗(yàn)對照組無明顯區(qū)別，可見以損傷區(qū)域?yàn)橹行男纬傻谋容^致密的組織圍繞在空腔周圍，組織細(xì)胞排列較有規(guī)律，走形與脊髓縱軸基本一致。 2.免疫組織化學(xué)染色結(jié)果 2.1GFAP免疫組織化學(xué)染色結(jié)果顯示，正常對照組在脊髓灰質(zhì)中GFAP陽性反應(yīng)細(xì)胞和陽性反應(yīng)纖維清晰可見；在脊髓白質(zhì)中，，GFAP免疫反應(yīng)陽性細(xì)胞和陽性纖維密集，可見GFAP免疫反應(yīng)陽性細(xì)胞星狀突起明顯，細(xì)胞多呈不規(guī)則多角形。實(shí)驗(yàn)組和實(shí)驗(yàn)對照組中的GFAP免疫反應(yīng)陽性細(xì)胞表達(dá)隨時間的推移而逐漸增多，相同時相點(diǎn)GFAP免疫反應(yīng)陽性未見明顯差異。脊髓損傷后1d，實(shí)驗(yàn)對照組和實(shí)驗(yàn)組脊髓損傷區(qū)組織結(jié)構(gòu)紊亂，可見GFAP免疫反應(yīng)陽性的細(xì)胞和纖維，損傷腔隙內(nèi)的組織碎片中見GFAP免疫反應(yīng)陽性細(xì)胞和陽性纖維。脊髓損傷后7d，實(shí)驗(yàn)對照組和實(shí)驗(yàn)組損傷區(qū)可見散在GFAP免疫反應(yīng)陽性細(xì)胞和陽性纖維，染色較淺，見大量炎性細(xì)胞浸潤。脊髓損傷后30d，實(shí)驗(yàn)對照組和實(shí)驗(yàn)組損傷區(qū)內(nèi)組織GFAP免疫反應(yīng)陽性表達(dá)較7d時增加，GFAP免疫反應(yīng)陽性細(xì)胞表達(dá)和GFAP陽性纖維表達(dá)增加，且GFAP免疫反應(yīng)陽性纖維交織成網(wǎng)。脊髓損傷后60d，實(shí)驗(yàn)對照組和實(shí)驗(yàn)組脊髓損傷組織結(jié)構(gòu)紊亂得到改善，損傷區(qū)內(nèi)組織填充，增生區(qū)內(nèi)GFAP免疫反應(yīng)陽性細(xì)胞和陽性纖維明顯增加，染色加深呈棕褐色并形成膠質(zhì)瘢痕，實(shí)驗(yàn)組與實(shí)驗(yàn)對照組比較無明顯差異。 2.2NF-200免疫組織化學(xué)染色結(jié)果顯示，實(shí)驗(yàn)對照組和實(shí)驗(yàn)組NF-200免疫反應(yīng)陽性纖維均呈先下降，隨時間推移逐漸增高的趨勢；脊髓損傷后1d，實(shí)驗(yàn)組與實(shí)驗(yàn)對照組在脊髓損傷區(qū)組織中和損傷間隙內(nèi)的組織塊中見有NF-200免疫反應(yīng)陽性細(xì)胞和陽性纖維；脊髓損傷后7d，實(shí)驗(yàn)組與實(shí)驗(yàn)對照組在脊髓損傷組織中NF-200免疫反應(yīng)陽性細(xì)胞和纖維表達(dá)較脊髓損傷后1d明顯下降，見少量NF-200免疫反應(yīng)陽性細(xì)胞和纖維分布；脊髓損傷后30d，實(shí)驗(yàn)對照組與實(shí)驗(yàn)組NF-200免疫反應(yīng)陽性表達(dá)隨時間推移逐漸增高；脊髓損傷后60d，實(shí)驗(yàn)對照組與實(shí)驗(yàn)組NF-200免疫反應(yīng)陽性纖維數(shù)量隨時間推移逐漸增加，在靠近正常脊髓側(cè)NF-200免疫反應(yīng)陽性纖維交織成網(wǎng)，在增生組織中可見少量NF-200免疫反應(yīng)陽性纖維。 結(jié)果提示： 1.護(hù)理干預(yù)可延緩肌肉萎縮速度、改善運(yùn)動功能，促進(jìn)損傷脊髓功能的部分恢復(fù)。這可能與早期介入相關(guān)功能恢復(fù)的刺激性護(hù)理干預(yù)，且持續(xù)進(jìn)行被動按壓皮膚、肌肉活動，促進(jìn)大鼠后肢血液循環(huán)、減輕后肢水腫，盡量保持大鼠后肢關(guān)節(jié)靈活性，防止后肢關(guān)節(jié)僵硬出現(xiàn)有關(guān)。 2.護(hù)理干預(yù)對損傷區(qū)脊髓組織形態(tài)學(xué)研究未見明顯改變，這可能與護(hù)理干預(yù)不足以明顯改善SCI后脊髓組織結(jié)構(gòu)內(nèi)繼發(fā)性損傷，如炎癥反應(yīng)、出血、神經(jīng)膠質(zhì)細(xì)胞大量增生、神經(jīng)元損傷后再生十分困難等有關(guān)。
[Abstract]:Research background:
Spinal cord injury (Spinal cord injury SCI) is the central nervous system (Central nervous system CNS) of serious injury, SCI often leads to severe neurological deficits and motor dysfunction. The main reason is the cause of survival in patients with.SCI patients with motor function recovery during the loss of self-care ability has been the focus of attention of both doctors and patients, and motor function training is an important method for motor function recovery of patients with spinal cord injury. Clinical studies have shown that, after spinal cord injury and to persevere in the early clinical nursing intervention can promote the movement of motor function in patients with spinal cord injury function recovery, but its mechanism is not very clear, need more basic research data as a support. Therefore, this study the nursing intervention of motor function in rats after spinal cord injury, the BBB score (Basso, Beattie and Bresnahanscore (Inc) and ramp test Lined-plane score IP Score), EMG and muscle weight detection, hematoxylin and eosin (Hematoxiline-eosin HE) staining, immunohistochemical staining (Immunohistochemistry IHC), the evaluation of nursing intervention on double hindlimb motor function in rats after spinal cord injury of gastrocnemius muscle response and muscle weight changes, optical microscope to observe the morphological changes of cross section of spinal cord injury, motor function in order to find the nursing intervention in the repair of spinal cord injury and the role of supporting evidence.
Objective:
Objective To observe the effect of nursing intervention on spinal cord motor function recovery after spinal cord injury in rats, and to explore the role of nursing intervention in repairing damaged spinal cord function, so as to provide evidence-based evidence for clinical nursing.
Materials and methods:
The 1. group: 60 SD adult rats (about 250g, male and female) were randomly divided into A group and normal control group. The B group was the experimental group and the C group as the experimental group and the three group (each group was n=20). The B group and C group were divided into four phases (1D, 7d, 30d and 30d) after spinal cord injury.
The 2. method:
2.1 rat models of spinal cord injury were prepared in group B and group C by cutting and extruding L4 horizontal transverse spinal cord to prepare the rat model of spinal cord injury.
2.2 nursing intervention group A rats as normal control group, routine nursing group B after spinal cord injury in rats, C rats after spinal cord injury and given nursing intervention.B group and C group rats were started by intraperitoneal injection of penicillin sodium 200 thousand U1 /d in 1D after spinal cord injury, continuous injection of 3D to prevent assist the injured rat infection, urination, defecation 2 times /d routine nursing; C group in addition to routine care, also give the bladder and abdominal massage, joint activity training and muscle massage training passive exercise training, nursing intervention were carried out immediately after the injury, after 2 times /d, 10min/ times / rats rat hind passive joint training activities, including passive knee flexion, knee passive hip abduction adduction and passive flexion, hip abduction adduction ankle passive, passive dorsiflexion and plantar flexion training, to maintain and improve the joint activity; muscle training to press and concentric ring Alternately massaging the feet, calves, and thigh muscles to reduce the edema of the double hind limbs and increase the circulation of the blood.
2.3BBB score and slope test were used to evaluate the motor function score of two hind limbs by BBB score and slope test. After four spinal cord injury, 1D, 7d, 30d and 60d were detected at the same time. The behavioral changes of spinal cord injury after nursing intervention were evaluated.
2.4 electromyographic response and muscle wet weight test. Electromyographic response and wet weight test were used to observe the changes of 1D, 7d, 30d and 60d in the gastrocnemius muscle of rats after spinal cord injury, and to compare the atrophy of denervated gastrocnemius muscles after spinal cord injury after nursing intervention.
2.5 routine HE staining was performed with histological section for HE staining to observe the tissue repair of spinal cord injury rats in each phase.
2.6 immunohistochemical staining by immunohistochemical staining of rat spinal cord injury groups each time point of neurofilament protein -200 (Neurofilament-200NF-200) and glial fibrillary acidic protein (Glial fibrillaryacidic protein GFAP) to observe the changes after spinal cord injury in rats by nursing intervention after GFAP immune response in each group at each time point neuronal NF-200 immunoreactive changes of glial cells and the positive changes.
Main results:
Part one: the effect of nursing intervention on the behavior of spinal motor function repair after spinal cord injury in rats
The 1.BBB score and the slope test results show that after a spinal cord injury 1D and 7d time point, the experimental group and experimental control group, nursing intervention BBB score and the slope test showed no significant difference (P > 0.05); after a spinal cord injury 30d and 60d time point, the experimental group than the control group (high P < 0.05), the hind limb function of experimental rats was significantly improved, but the experimental group and experimental control group were lower than those of the normal control group, did not reach the normal level.
2. gastrocnemius electromyographic reaction results showed that at the time of 30d and 60d after spinal cord injury, there was fibrillation potential in the experimental group and the experimental control group, and the amplitude of fibrillation potential wave in the experimental group was higher than that in the experimental group (P < 0.05), which was statistically significant.
3. gastrocnemius muscle wet weight results show that in 60d phase after spinal cord injury, the experimental group and experimental control group of gastrocnemius wet weight compared with normal control group significantly reduced (P < 0.01), compared with experimental control group and experimental group, experimental group gastrocnemius wet weight decreased in the control group (P light < 0.05), the difference was statistically significant.
The second part: the effect of nursing intervention on the morphological changes of motor function of spinal cord after spinal cord injury in rats
1. HE staining results
1D after spinal cord injury, the experimental group and experimental control group HE staining in the area of spinal cord injury were found bleeding and mild inflammatory reaction, debris in the injury lacuna of visible tissue; 7d after spinal cord injury, injury of spinal cord tissue structure disorder, inflammatory cell infiltration, increased inflammatory reaction, and also various cell hyperplasia visible hyperplasia of capillaries, neuron swelling, necrosis, protrusions disappear; 30d after spinal cord injury, the experimental group and experimental control group showed spinal cord injury inflammatory reaction relieved or disappeared, had cystic cavity like changes or cavity. Tissue filling, cell proliferation obviously, proliferation of cells in a certain direction, a cluster arrangement of hyperplasia seen in the tissue hyperplasia of capillaries; 60d after spinal cord injury, improve the injury of spinal cord tissue structure, no obvious difference between experimental group and experimental control group, visible to the damage area as the center of the formation The more dense tissue around the cavity around the tissue cells arranged in a regular shape, and the spinal cord are basically the same. The vertical axis
2. immunohistochemical staining results
2.1GFAP immunohistochemical staining showed that the normal control group in spinal cord gray matter, GFAP positive cells and positive fibers visible; in the white matter of the spinal cord, GFAP immunoreactive cells and fibers were dense, visible GFAP immunoreactive cells and stellate cells showed obvious bulge, irregular polygon. The GFAP immune response positive cells in the experimental group and experimental control group the expression gradually increased with the passage of time and the same time point GFAP immunoreactive had no significant difference. After spinal cord injury 1D, experimental control group and experimental group of spinal cord injury tissue structure disorder, cells and fibers were GFAP immunoreactive, GFAP immunoreactive the positive cells and fiber damage lacunae tissue fragments. 7d after spinal cord injury, experimental control group and experimental group injury found in GFAP immunoreactive cells and Positive fibers, lighter staining, infiltration of inflammatory cells. 30d after spinal cord injury, experimental control group and experimental group GFAP immunoreactive positive expression of tissue injury in the region increased 7d, GFAP immunoreactive cells and the expression of GFAP positive fibers and increased expression of GFAP immunoreactivity positive fibers woven into the spinal cord net. 60d after injury, the experimental control group and experimental group of spinal cord injury tissue structure disorder improved damage zone tissue filling, hyperplasia of GFAP immunoreactive positive cells and fibers in the region increased significantly, and the formation of brown stained glial scar, no significant difference between the experimental group and the control group.
2.2NF-200 immunohistochemical staining showed that the experimental control group and experimental group of NF-200 immunoreactive fibers were decreased first and increased gradually with time trend; 1D after spinal cord injury, the experimental group and experimental control group in the area of spinal cord injury and tissue injury in the gap tissue in NF-200 immunoreactive cells and positive fiber; 7d after spinal cord injury, the experimental group and experimental control group injury NF-200 immunoreactive positive cells in the tissue and fiber expression after spinal cord injury 1D significantly decreased in the spinal cord, a few NF-200 immunoreactive cells and fibers; 30d after spinal cord injury, experimental control group and experimental group NF-200 positive expression increased gradually with the passage of time; 60d after spinal cord injury, experimental control group and experimental group NF-200 immunoreactive fibers increased with the elapse of time, is near The NF-200 immunoreactive fibers in the normal spinal cord were interwoven into the net, and a small amount of NF-200 immunoreactive fibers were found in the proliferative tissue.
The results suggest:
1. nursing intervention can delay the speed of muscle atrophy, improve motor function, promote the recovery of function after spinal cord injury. It may be stimulating nursing intervention and early intervention related functional recovery, and continuous passive pressing skin, muscle activity, promote hindlimb blood circulation, reduce limb edema, keep rat hindlimb joint flexibility. Prevent hindlimb joint stiffness.
2. nursing intervention could alter the spinal cord morphology of no may be related to the nursing intervention to improve the organizational structure within SCI after spinal cord injury, such as inflammation, bleeding, glial cell proliferation, neuronal regeneration after injury is very difficult and so on.

【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R473.6

【共引文獻(xiàn)】

相關(guān)期刊論文 前3條

1 Martin OudegaO;;Survival of transplanted neurotrophin-3 expressing human neural stem cells and motor function in a rat model of spinal cord injury[J];Neural Regeneration Research;2009年07期

2 ;Neurofilament 200 expression in a rat model of complete spinal cord injury following growth-associated protein-43 treatment[J];Neural Regeneration Research;2009年11期

3 ;Repair of spinal cord injury by neural stem cells transfected with brain-derived neurotrophic factor-green fluorescent protein in rats A double effect of stem cells and growth factors?[J];Neural Regeneration Research;2010年17期

相關(guān)博士學(xué)位論文 前2條

1 巴迎春;NSC移植對SCT大鼠行為改進(jìn)、神經(jīng)再生、NTF表達(dá)及其信號通路分子的影響[D];昆明醫(yī)學(xué)院;2010年

2 吳海鷹;電針對SCI大鼠軸突及干細(xì)胞可塑性影響及相關(guān)機(jī)制研究[D];昆明醫(yī)科大學(xué);2013年

相關(guān)碩士學(xué)位論文 前1條

1 何生;力竭運(yùn)動后大鼠海馬NF-κB、BDNF的表達(dá)變化[D];山西醫(yī)科大學(xué);2011年

本文編號：1356513