抑郁复合皮肤创伤对大鼠创面愈合的影响

发布时间：2017-12-30 21:30

本文关键词：抑郁复合皮肤创伤对大鼠创面愈合的影响　出处：《第三军医大学》2007年硕士论文　论文类型：学位论文

【摘要】： 随着社会的不断进步和医学的迅速发展,人类许多疾病已逐步得到有效的控制,但创伤却随着现代文明的发展不断增多,围绕创面愈合的研究也成为创伤外科和军事医学领域中备受关注的问题之一。皮肤是机体防御外界刺激和损伤的第一道屏障,在绝大部分创伤中都会有皮肤损伤存在,因而,皮肤的创面愈合与组织修复成为近年创伤研究中最具潜力和引人注目的部分。多年来,创伤研究工作者运用组织病理学、生物化学、药物学、生物材料学,以及外科学等手段对创面修复的过程、发生机制、临床治疗等多方面进行了较深入的研究,取得了一定成就。然而,由于创面愈合是一个非常复杂的生物学过程,创面的愈合时间和修复程度既与损伤程度和组织再生能力有关,也受机体全身和局部条件的影响。目前,人们不仅已对感染、缺血、缺氧、营养不良、激素及抗肿瘤药等对创面愈合的影响进行了深入探讨,而且也已深刻认识到某些疾病如放射病、糖尿病等在慢性难愈性创面发生发展过程中的作用,特别是近年国内外学者在放创复合伤研究领域取得了一系列突破性研究成果,标志着创面修复的研究获得了突飞猛进的发展。但临床观察发现,同样伤型,相似生理条件的伤者,其伤口愈合时间可差别较大,有的甚至成为难愈性创伤。因此,迄今为止,创伤难愈的原因仍未完全阐明。随着医学模式的转变,心理因素对健康的影响已得到人们的公认。由于生活节奏的加快和社会竞争的加剧,近年抑郁症的发病率正快速攀升。世界大型流行病学研究显示,抑郁症目前在世界致残性疾病中排名第四,估计到2020年,抑郁将成为世界第二大健康负担,成为仅次于心脏病的世界第二“杀手”。因此,抑郁症受到临床心理学及医学界的高度重视,它对人类身体健康构成的巨大威胁也引起了人们的广泛关注。临床观察发现,抑郁、焦虑患者创伤愈合时间可4倍于正常人群;在难愈性创伤中,患者常常伴有明显的抑郁情绪。由此,我们假设心理因素,特别是抑郁可能是影响皮肤创面愈合的重要原因之一。但目前国内外这方面的研究报道极少,且已有研究基本局限在临床观察方面,采用的研究手段也多为调查性研究,国内外相应的实验性研究均十分少见,对其影响机制更缺乏系统研究。为此,本课题拟通过实验性研究手段,以大鼠为实验对象,探讨抑郁复合皮肤创伤对创面愈合的影响,以期为复合伤中躯体损伤复合心理损伤的防治提供理论和实践依据。研究共分两部分进行:①首先建立抑郁复合皮肤创伤动物模型,并对该模型的有效性和可行性进行评价;②在成功建立动物模型的基础上,观察抑郁复合皮肤创伤对创面愈合的影响,并初步探讨其影响创面愈合的机制,得到主要结果如下: 1.通过慢性轻度不可预见性刺激结合孤养并机械致皮肤创伤,经旷场实验、液体消耗实验等证实,该模型不仅能较好地模拟人类抑郁症的诸多症状,且复合全层皮肤缺损,是一个理想的抑郁复合皮肤创伤动物模型,为开展相关研究奠定了基础。 2.无论抑郁复合皮肤创伤,还是皮肤创伤复合抑郁,都可显著延缓创面的愈合速度及愈合时间。其中抑郁复合皮肤创伤大鼠的创面愈合时间为19~24天,平均(22.17±1.72)天;皮肤创伤复合抑郁大鼠的创面愈合时间为19~25天,平均(23.00±2.28)天;单纯皮肤创伤组大鼠的创面愈合时间为16~19天,平均(17.50±1.38)天。说明抑郁是造成创伤难愈不容忽视的因素之一。 3.在观察到抑郁复合皮肤创伤显著延缓大鼠皮肤创面愈合的基础上,我们通过形态学和免疫组化等方法进一步探讨了其影响创面愈合的机制,发现:抑郁复合皮肤创伤大鼠创面局部毛细血管的生成受抑制、成纤维细胞减少、胶原合成速度延缓、羟脯氨酸合成量减少,从而影响创面肉芽组织的生成数量和质量,造成创面愈合延迟。
[Abstract]:With the rapid development of society and the progress of medicine, many human diseases have been effectively controlled, but the trauma is increasing with the development of modern civilization, the study of wound healing has become a concern in trauma surgery and military medicine problems. The skin is the first barrier to external stimulation and injury the most of traumas involve skin injury. Therefore, skin wound healing and tissue repair trauma research in recent years become a promising and attractive part.
Over the years, trauma researchers by histopathology, biochemistry, pharmacology, biological materials, mechanism and process of surgery of wound repair, in-depth clinical treatment and other aspects, has made some achievements. However, because of the wound healing is a complex biological process and the ability of wound healing time and degree of repair and degree of injury and regeneration, but also affected by systemic and local conditions. At present, people not only have the infection, ischemia, hypoxia, malnutrition, hormone and anti tumor drugs were studied on the wound healing effect, but also has a profound understanding to some diseases such as radiation disease, diabetes in pathogenesis of chronic wounds, especially in recent years, domestic and foreign scholars in the field of radiation combined wound and made a series of process Breaking of research results, marking the wound repair research has gained rapid development. But the clinical observation found that the same type of injury, similar to the physiological condition of the injured, the wound healing time can vary greatly, some even become refractory wounds. Therefore, so far, has not been fully elucidated. The reason of wound healing
With the transformation of medical model, effects of psychological factors on health has been widely recognized. Due to the accelerated pace of life and social competition in recent years, the incidence of depression is rising rapidly. World major epidemiologic study shows that depression at present in the world disabling disease ranked fourth, estimated that by 2020, depression will become the world's second the health burden of heart disease, become the second world second "killer". Therefore, depression is highly valued by the clinical psychology and medical field, it constitutes a great threat to human health has also aroused people's attention. The clinical observation that patients with anxiety, depression, wound healing time can be 4 times more than in normal people; refractory trauma, patients often accompanied by obvious depression. Thus, we hypothesize that psychological factors, especially depression may affect the skin wound healing One of the important reasons. But the current domestic and foreign research reports in this area is few, and the existing research is limited in clinical observation, the methods are mostly research and investigation, the corresponding experimental research at home and abroad are very rare, but the lack of systematic study on the influence mechanism. Therefore, this project intends to experimental study on means to rats as experimental objects, the effects of depression combined with skin injury on wound healing, in order to provide theoretical and practical basis for the prevention of injury in body injury combined with mental injury. The study is divided into two parts: firstly, the establishment of depression combined with skin injury animal model, and the effectiveness of the the model and the feasibility of the evaluation; the establishment of animal model of success, to observe the depression combined with skin injury on wound healing, and to explore the influence of the mechanism of wound healing, too The main results are as follows:
1. by chronic unpredictable mild stimulation combined with lonely feed and mechanically induced skin trauma, after the open field test, fluid consumption demonstrated that many symptoms of this model can not only simulate human depression, and the composite of full-thickness skin defect, is an ideal animal model of depression combined with skin injury, laid the foundation in order to carry out related research.
2. both the depression combined with skin trauma, or skin trauma combined with depression can significantly delay the speed of wound healing. The wounds of depression combined with rat skin wound healing time was 19~24 days, average (22.17 + 1.72) days; skin trauma combined with depression rats healing time was 19~25 days (average. 23 + 2.28) days; simple wound group rats skin wound healing time was 16~19 days, average (17.50 + 1.38) days. That depression is one of the factors causing the wound healing can not be ignored.
3. based on the observed depression combined with skin injury significantly delayed wound healing in rats, we used morphological and immunohistochemical methods to further explore the influencing mechanism of wound healing: depression combined with skin injury rat wound capillary into inhibited fibroblast collagen synthesis decreased, slow the pace, hydroxyproline synthesis was reduced, thus affecting the quantity and quality of granulation tissue formation, resulting in delayed wound healing.

【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R395

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