本文選題：犬　切入點(diǎn)：脊髓損傷　出處：《大連醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：研究目的:急性脊髓損傷(Spinal Cord Injury,SCI)是急診創(chuàng)傷常見(jiàn)的高致殘疾病之一。目前脊髓損傷的急診室處理集中關(guān)注在生命支持、脊柱的固定及防止二次損傷。但大量文獻(xiàn)表明這些處理并不能降低SCI患者的致殘率,并提出這與撞擊性SCI脊髓的繼發(fā)性損傷密切相關(guān)。SCI的繼發(fā)性損傷是脊髓中央灰質(zhì)出血、脊髓血流銳減及缺血再灌注損傷導(dǎo)致神經(jīng)元細(xì)胞水腫、脂質(zhì)過(guò)氧化、自由基的形成、細(xì)胞膜溶解和炎癥等級(jí)聯(lián)反應(yīng),最終細(xì)胞凋亡或壞死。脊髓血流(Spinal Cord Blood Flow,SCBF)的變化是參與SCI繼發(fā)性損傷的重要因素之一,所以研究脊髓血流變化是研究SCI的病理生理機(jī)制的重要部分。脊髓結(jié)構(gòu)中央主要為神經(jīng)元細(xì)胞構(gòu)成的蝶形灰質(zhì)區(qū)和四周被有髓纖維細(xì)胞構(gòu)成的白質(zhì)區(qū)。目前SCBF的監(jiān)測(cè)方法常用監(jiān)測(cè)探頭位于脊髓表面,實(shí)時(shí)分區(qū)域的血流監(jiān)測(cè)還沒(méi)見(jiàn)報(bào)道,灰質(zhì)與白質(zhì)不同區(qū)域的血流在撞擊性SCI后的變化規(guī)律還不十分清楚。因此本課題針對(duì)SCBF監(jiān)測(cè)方法的不足,利用針刺式探頭激光多普勒血流監(jiān)測(cè)儀(Needle Probe—Laser Doppler Flowmetry,NP—LDF)監(jiān)測(cè)犬撞擊性SCI急性期脊髓不同區(qū)域的SCBF,初步觀察其在SCI后的灰質(zhì)與白質(zhì)不同區(qū)域變化規(guī)律,為進(jìn)一步了解其病理機(jī)制及臨床救治提供初步理論依據(jù)。實(shí)驗(yàn)方法:8只比格犬根據(jù)隨機(jī)數(shù)字表法隨機(jī)分為對(duì)照組2只,SCI組6只。對(duì)照組只去除犬胸12-胸13(T12-T13)節(jié)段脊髓后方結(jié)構(gòu)暴露脊髓,不進(jìn)行撞擊損傷;SCI組去除犬T12-T13脊髓后方結(jié)構(gòu)并利用數(shù)控電機(jī)撞擊裝置進(jìn)行脊髓損傷造模。SCI組動(dòng)物使用NP—LDF分別于脊髓暴露時(shí),SCI后第5min,第60min,第7 d,第3 w,對(duì)照組動(dòng)物與SCI組動(dòng)物對(duì)應(yīng)時(shí)間對(duì)脊髓損傷處中央灰質(zhì)區(qū)、腹側(cè)白質(zhì)區(qū)及背側(cè)白質(zhì)區(qū)血流進(jìn)行監(jiān)測(cè);兩組動(dòng)物術(shù)后第1d,第7d,第3w進(jìn)行神經(jīng)電生理檢測(cè):體感誘發(fā)電位(Somatosensory Evoked Potentials,SEP)和運(yùn)動(dòng)誘發(fā)電位(Motor Evoked Potentials,MEP),并利用TSCIS法評(píng)估犬后肢行為學(xué)功能。SCI組動(dòng)物分別于術(shù)后第7d、第3w隨機(jī)選取3只處死,取標(biāo)本進(jìn)行組織病理學(xué)觀察。實(shí)驗(yàn)結(jié)果:1.SCI組所有動(dòng)物造模成功并進(jìn)入實(shí)驗(yàn);2.SCBF值:兩組動(dòng)物在脊髓暴露時(shí)中央灰質(zhì)基礎(chǔ)值與腹側(cè)白質(zhì)基礎(chǔ)值、背側(cè)白質(zhì)基礎(chǔ)值差異均有統(tǒng)計(jì)學(xué)意義(P0.05);腹側(cè)白質(zhì)基礎(chǔ)值與背側(cè)白質(zhì)基礎(chǔ)值差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);SCI組與對(duì)照組脊髓各區(qū)域SCBF值在術(shù)后各相應(yīng)時(shí)間節(jié)點(diǎn)比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05);SCI組中央灰質(zhì)區(qū)、腹側(cè)白質(zhì)區(qū)及背側(cè)白質(zhì)區(qū):SCI后第5min與SCI后第60 min、第7 d、第3 w SCBF值比較及術(shù)后第60min與術(shù)后第7d、第3w SCBF值比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05),SCI后第7d與第3w比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);SCI后第5min、第60min、第7d、第3w與脊髓暴露時(shí)比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。3.TSCIS評(píng)分:對(duì)照組動(dòng)物術(shù)后第1d、第7d、3w評(píng)分均為20分;SCI組中SCI后第1 d均值為0分、第7 d、第3 w TSCIS值均為0.33±0.52分,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);與對(duì)照組比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05);4.神經(jīng)電生理監(jiān)測(cè):MEP及SEP在SCI各時(shí)間點(diǎn)均未發(fā)現(xiàn)任何波動(dòng)記錄,雙后肢逐漸攣縮,僅靠前肢活動(dòng)。5.組織學(xué):SCI后第7d病理切片示:脊髓部分失去正常組織,中央灰質(zhì)壞死,囊腔形成;SCI后第3 w病理切片示:脊髓完全失去正常組織,灰質(zhì)與白質(zhì)未見(jiàn)明顯界限,多囊腔中出現(xiàn)膠質(zhì)細(xì)胞。實(shí)驗(yàn)結(jié)論:1.NP—LDF能夠精確地測(cè)量脊髓中央灰質(zhì)、腹側(cè)白質(zhì)、背側(cè)白質(zhì)的血流;2.脊髓中央灰質(zhì)、腹側(cè)白質(zhì)、背側(cè)白質(zhì)的血流在撞擊性SCI后短暫上升然后隨著時(shí)間變化迅速下降,最后到達(dá)穩(wěn)定。說(shuō)明SCI繼發(fā)性損傷在原發(fā)性損傷后隨之而來(lái);3.本實(shí)驗(yàn)中使用NP-LDF刺入脊髓對(duì)SCBF進(jìn)行監(jiān)測(cè),雖然為有創(chuàng)監(jiān)測(cè)手段,但在課題研究顯示探頭刺入脊髓對(duì)脊髓功能是沒(méi)有影響的,且能更為準(zhǔn)確地反映SCI后脊髓血供的變化。
[Abstract]:Objective: To study the acute spinal cord injury (Spinal Cord, Injury, SCI) is one of the common diseases with high mutilation trauma. The spinal cord injury treatment in the emergency room focus on life support and fixation of the spine and prevent the two damage. But a large number of literatures show that the treatment does not reduce the rate of disability in patients with SCI, and put forward the secondary the secondary injury of spinal cord injury and the impact of SCI.SCI is closely related to the central gray matter of spinal cord hemorrhage, spinal cord blood flow decreased and ischemia reperfusion injury lead to neuronal cell edema, lipid peroxidation, free radical formation, cell membrane dissolution and the grade of inflammation cascade reaction, the final cell apoptosis or necrosis of spinal cord blood flow (Spinal Cord Blood. Flow, SCBF) change is one of the important factors involved in secondary injury of SCI, so the study of spinal cord blood flow change is an important part of the research on the pathophysiological mechanism of SCI. The structure of spinal cord The central main neurons of a butterfly shaped region surrounded by a gray and white matter regions constitute medullary fiber cells. The monitoring method of SCBF common monitoring probe is positioned on the surface of spinal cord blood flow monitoring, real time region has not been reported. The variation of gray matter and white matter in different regions of the blood flow in the SCI after the crash not very clear. Therefore the issue for SCBF monitoring method, using needle type probe of laser Doppler flowmetry (Needle Probe - Laser Doppler Flowmetry, NP LDF) monitoring dog impact SCI acute spinal cord in different regions of the SCBF, to observe its changes in different regions after SCI provides gray matter and white matter. A preliminary theoretical basis for further understanding of the pathogenesis and clinical treatment. Methods: 8 beagle dogs according to randomly divided into control group 2, SCI group 6. Control group only removal Chest 12- chest 13 (T12-T13) structure of spinal cord posterior exposed spinal cord, without impact damage; group SCI removal of canine T12-T13 spinal cord posterior structure and the use of CNC electric percussion device for a spinal cord injury animal model group.SCI using NP - LDF in the spinal cord were exposed after SCI, 5min, 60min, D seventh. Third w control group and SCI group of animal animal injury at the corresponding time central gray area of spinal cord, ventral and dorsal white matter white matter blood flow monitoring; animal operation in two groups after 1D, 7d, 3W for electrophysiological examination: somatosensory evoked potential (Somatosensory Evoked Potentials, SEP motor evoked potentials (Motor) and Evoked Potentials, MEP), and to evaluate the canine hindlimb behavior.SCI group animal respectively after 7d using the TSCIS method, the 3W randomly selected 3 rats, specimens were taken for histopathological observation. Results: in group 1.SCI, all animal 妯℃垚鍔熷茍榪涘叆瀹為獙;2.SCBF鍊，

本文編號(hào)：1565510