单侧膈肌麻痹对呼吸功能影响的实验研究
发布时间：2018-08-09 07:18
【摘要】：第一部分大鼠单侧膈肌麻痹模型的建立实验一大鼠副膈神经的解剖观察目的观察大鼠颈部副膈神经(APN)的解剖位置和走行,探索寻找APN的部位。方法雌性SD大鼠28只,颈部显露双侧膈神经(PN)和副膈神经(APN)。记录APN的出现率、发出部位、走行及跨C7前方的相对位置,分别测量PN和APN的直径、C7神经根水平PN与APN之间的距离。结果APN出现率91.1%,其中左侧92.8%,右侧89.3%。发自C6神经根、上干、上干前股根部、上干前股者分别占9.8%、23.53%、49.02%、17.65%。所有的APN由臂丛神经各部位发出后,均沿臂丛神经相同的走行方向独立走行少许后转向下或内下方向,于PN的外侧进入胸廓上口。在下行过程中,APN走行在C7前方内、中、外1/3的分别占54.9%、23.53%、21.57%。APN直径0.14±0.01mm(0.09-0.18mm),约占PN直径(0.32±0.02mm)(0.21～0.43mm)的44%。跨越C7神经根前方时,APN与PN之间平均相距0.36±0.06mm(0～1.64mm)。结论1.大鼠副膈神经的出现率较高,比膈神经细小,可发自C6神经根、上干、上干前股根部和上干前股,沿臂丛方向走行少许后转向内下进入胸腔。2.应在膈神经外侧、与C6神经根、上干、上干前股内侧的间隙中寻找副膈神经。实验二大鼠单侧膈肌麻痹模型的建立与评价目的采用在颈部分别切断膈神经(PN)和副膈神经(APN)的方法建立大鼠单侧膈肌麻痹模型,并对模型进行评价。方法雌性SD大鼠24只,随机分为3组。左侧为实验侧。将膈肌分成5个部分：胸骨部(st)、前肋部(an)、中肋部(mid)、后肋部(po)和腰部(1u)。在实验处理前先采集左右两侧膈肌共10个部位的EMG做基线对照。制作动物模型：A组：颈部切断PN和APN；B组：仅切断PN;C组：对照组。各组神经处理完毕后30min再次记录两侧膈肌EMG。术后4W,进行肺功能、膈肌大体观察和电生理活动以及两侧不同部位膈肌、入肌前膈神经的病理组织学检测。结果1.术后30min：A组患侧各部位膈肌完全麻痹,均无可见收缩,未引出EMG；健侧膈肌EMG活动明显增强。B组患侧膈肌不全麻痹,EMG st、an消失,EMGpo、lu存在；健侧膈肌活动也有增强。2.术后4W：A组潮气量(TV)明显小于B、C组(P0.05),其它参数与B、C组相比无显著差异；而B、C组间肺功能所有参数均无显著差异。A组患侧膈肌仍完全麻痹；B组患侧膈肌麻痹范围缩小,可引出EMG的范围增大。入肌前患侧膈神经有髓神经纤维数目B、C组分别为78±13根、447±56根,有显著差异(P0.05),而A组无有髓神经纤维。患侧各部位膈肌肌纤维平均截面积A组均小于C组(P0.05)；而B组仅胸骨部(st)小于C组(P0.05)(与A组无差异),其余部位与C组无差异。结论采用在颈部分别切断膈神经和副膈神经的方法能够制作可靠的大鼠单侧膈肌麻痹模型。电生理活动以及两侧不同部位膈肌、入肌前膈神经的病理组织学检测。第二部分单侧膈肌麻痹对大鼠肺功能的影响目的评价单侧膈肌麻痹对大鼠静息和运动后肺功能的影响,从肺功能的角度探讨膈神经移位或结合2根肋间神经移位修复臂丛神经损伤的安全性,以及修复膈神经的必要性和有效性。方法雌性SD大鼠132只,随机分为4组。左侧为实验侧。A组在颈部将膈神经(PN)和副膈神经(APN)均切断：B组在将PN和APN均切断的同时用第3、4肋间神经(ICN)运动支经神经移植修复颈部PN远端；C组在切断PN、APN的同时再切断第3、4 ICN运动支；D组为对照组。术后1、2、4、8、12、24W进行静息肺功能、中等强度有氧运动后肺功能和递增运动试验力竭时间的检测。结果静息状态下A、B、C组的PIF显著小于D组(P0.05)(A、B、C组间无差异),其他参数MV、F、TV、Ti、Te、PEF、EF50各组间均无显著差异。运动前、后的肺功能动态变化显示,术后1W,A组运动后即刻的F、MV明显小于D组(P0.05),Ti明显大于D组(P0.05)；运动停止后12～15min,A组的MV与D组无明显差异(P0.05)；而F和Ti仍与D组有显著差异(P0.05),A组F大于D组,Ti小于D组。术后2、4、8、12、24W,各组间各参数均无显著差异。术后各时间点的力竭时间均无组间差异(P0.05)。结论1.单侧膈肌麻痹对静息肺功能有一定程度的持续性损害(主要为PIF降低),但不影响通气量和呼吸模式。2.单侧膈肌麻痹后早期,中等强度有氧运动中存在通气量减低和运动后恢复期延长,之后能逐渐恢复。对高强度运动能力无明显影响。3.膈神经伴2根肋间神经损伤不会进一步影响肺功能,两者同时移位修复臂丛神经损伤是安全的。4.肋间神经修复膈神经后静息和运动后的肺功能与单侧膈肌麻痹后不修复膈神经相比无明显差异。第三部分单侧膈肌麻痹对大鼠膈肌功能的影响目的评价单侧膈肌麻痹对大鼠膈肌功能的影响,从膈肌功能的角度探讨肋间神经修复膈神经的有效性和必要性。方法SPF级雌性SD大鼠132只,随机分为4组。左侧为实验侧。A组在颈部将膈神经(PN)和副膈神经(APN)均切断；B组在将PN和APN均切断的同时用第3、4肋间神经(ICN)运动支经神经移植修复颈部PN远端；C组在切断PN、APN的同时再切断第3、4ICN运动支；D组为对照组。术后1、2、4、8、12、24W分别进行生理、电生理和病理组织学检测。结果1.平静呼吸时食道内压(Peso)和膈肌EMG。术后各时间点各组间Peso无显著差异。健侧EMG:A、B、C组的EMG活动在术后1、2W时均大于D组(P0.05),之后与D组无明显差异。患侧EMG：A、C组未引出；B组在术后4W也未引出,在术后8、12、24W可引出逐渐增强的EMG,术后8、12W时小于D组(P0.05),术后24W时与D组无显著差异。2.大鼠喷嚏时的Peso和健侧膈肌EMG。术后各时间点各组间均无显著差异。3.健侧膈肌EMG频谱分析。高/低频比值(H/L)术后各时间点各组间无显著差异(P0.05)。中心频率(Fc)在术后1、2W时无组间差异；术后4、8W A、B、C组D组(P0.05)：术后12WA、B、C组B、D组(P0.05)；术后24WA、C组B、D组(P0.05)。4.膈肌CMAP。健侧：术后各时间点各组的Amp和Lat均无显著差异(P0.05)。患侧：A、C组术后未引出；B组在术后4W也未引出,在术后8、12、24W可引出与D组相比Amp低、Lat长的CMAP(P0.05)。5.膈肌肌纤维平均截面积。患侧：术后1、2W各组间无差异；术后4W,A、B、C组D组(P0.05)；术后8、12、24W,A、C组B、D组(P0.05)。健侧：术后1、2、4、8、12W各组间均无显著差异；术后24W,A、C组B、D组(P0.05)。6.肺泡隔面密度。术后各时间点各组间均无显著差异。7.患侧入肌前膈神经有髓神经纤维数目。A、C组无有髓神经纤维；术后4、8、12、24W,B组有髓神经纤维数目均少于D组(P0.05)。结论1.单侧膈肌麻痹后仍然可以产生平静呼吸时的正常胸腔内压力。健侧膈肌无疲劳。2.膈神经和2根肋间神经同时移位修复臂丛神经损伤不会引起呼吸系统的失代偿。3.与单侧膈肌麻痹后不修复膈神经相比,肋间神经修复膈神经无明显功能上的优势。
[Abstract]:The first part of the rat phrenic paralysis model was established to observe the anatomical observation of the accessory phrenic nerve in rats. The anatomical position of the accessory phrenic nerve (APN) in the neck of the rat was observed and the location of the APN was found. Methods 28 female SD rats were treated with bilateral phrenic nerve (PN) and the accessory phrenic nerve (APN) in the neck. The occurrence rate of APN was recorded and the location of the rat was recorded. The diameter of PN and APN and the distance between PN and APN at the level of C7 nerve root were measured respectively. Results the occurrence rate of APN was 91.1%, of which the left side was 92.8%, the right 89.3%. originated from the C6 nerve root, the upper trunk, the anterior femoral root, and the upper trunk 9.8%, 23.53%, 49.02%, and all APN of the 17.65%. were issued by the brachial plexus. In the same direction of the brachial plexus, they walked independently to the lower or lower direction of the PN, and entered the upper thoracic cavity on the outside of the PN. In the process of downlink, APN walked in front of C7, middle and outer 1/3 accounted for 54.9%, 23.53%, 21.57%.APN diameter 0.14 + 0.01mm (0.09-0.18mm), about PN diameter (0.32 + 0.02mm) (0.21 ~ 0.43mm) 44%. across C 7 the average distance between APN and PN was 0.36 + 0.06mm (0 ~ 1.64mm) in front of the nerve root. Conclusion the incidence of parphial nerve in the 1. rats is higher than that of the phrenic nerve. It can originate from the C6 nerve root, up the trunk, the femoral root and the upper trunk before the upper trunk, and go along the brachial plexus to the thoracic cavity and enter the thoracic cavity to the outside of the phrenic nerve, with the C6 nerve root and up to the upper trunk. The establishment and evaluation of unilateral diaphragm paralysis model in two rats was established and evaluated by cutting the phrenic nerve (PN) and accessory phrenic nerve (APN) in the neck to establish the rat unilateral diaphragm paralysis model, and the model was evaluated. Methods 24 female SD rats were randomly divided into 3 groups. The left side was real. The diaphragmatic muscles were divided into 5 parts: the sternum (st), the anterior rib (an), the middle rib (MID), the posterior rib (PO) and the waist (1U). Before the experimental treatment, the EMG was taken as the baseline control. The animal model was made: the A group: the neck severed PN and APN; the B group: only the PN; the C group: the control group was finished. After 30min, the lung function, the general observation of the diaphragm and the electrophysiological activities and the phrenic muscle in different parts of the two sides and the phrenic nerve were detected by histopathology. Results after 1., the diaphragmatic muscles of each part of the side of the 30min:A group were completely paralyzed, without visible contraction, without EMG, and the EMG activity of the contralateral diaphragmatic muscle was obviously enhanced. B group suffered from incomplete paralysis of the phrenic muscle, EMG st, an disappeared, EMGpo, Lu existed, and the activity of the contralateral diaphragm muscle activity also enhanced the tidal volume of 4W:A group (TV) after.2. operation (TV) was significantly smaller than B, C group (P0.05), but there was no significant difference in all parameters of lung function between the groups. The scope of arthralgia narrowed, the range of EMG was increased. The number of myelinated nerve fibers in the phrenic nerve before entering the muscle was B, and the group C was 78 + 13 and 447 + 56 respectively. There was a significant difference (P0.05), while the A group had no myelinated nerve fibers. The average cross-sectional area of the phrenic muscle fiber in the affected side of the affected side was smaller than that of the C group (P0.05); and the only sternal part (st) was smaller than the C group (P0.05) (P0.05) in the B group. There was no difference between the other parts of the group) and the other parts were not different from that in the C group. Conclusion using the method of severing the phrenic and accessory phrenic nerve in the neck can make a reliable model of unilateral diaphragm paralysis in rats. Electrophysiologic activity and the diaphragmatic muscles of different parts of the two sides and the pathological examination of the phrenic nerve before entering the muscle. The second part of unilateral diaphragm paralysis has the function of pulmonary function in rats. Objective to evaluate the effect of unilateral diaphragmatic paralysis on the resting and postoperative pulmonary function in rats. The safety of phrenic nerve transfer or 2 intercostal nerve transposition for repair of brachial plexus injury, and the necessity and effectiveness of repairing the phrenic nerve were investigated from the point of view of the lung function. Methods 132 female SD rats were randomly divided into 4 groups. In the lateral.A group, the phrenic nerve (PN) and the accessory phrenic nerve (APN) were cut off in the neck. Group B was used to repair the distal end of the neck with the motor branch of the intercostal nerve (ICN), while PN and APN were cut off, while the C group was cut off PN, and the APN was at the same time. Results the PIF of A, B, C in group C was significantly less than that of group D (P0.05) (A, B, C group), and there were no significant differences between the other parameters of A, B, C group. Obviously less than group D (P0.05), Ti was significantly greater than group D (P0.05), and there was no significant difference between MV and D group in group A after 12 to 15min (P0.05), while F and Ti still had significant differences. 0.05) 0.05. Conclusion 1. unilateral diaphragmatic paralysis has a certain degree of sustained damage to resting lung function (mainly reduced), but it does not affect the volume of ventilation and the early stage of respiratory mode.2. unilateral diaphragm paralysis. There is a decrease of ventilation in the middle intensity aerobic exercise and the prolonged recovery period after exercise, and it can be gradually recovered after the exercise. The ability to exercise high intensity is not clear. The effect of.3. phrenic nerve with 2 intercostal nerve injuries does not further affect the pulmonary function. Both the two simultaneous displacement repair of the brachial plexus injury is a safe.4. intercostal nerve repair of the phrenic nerve after the phrenic nerve repair and the pulmonary function after the unilateral diaphragm paralysis does not repair the phrenic nerve after the unilateral diaphragm paralysis. The third part of unilateral diaphragm paralysis in rats Objective to evaluate the effect of diaphragmatic function on the function of diaphragmatic muscle in rats and to explore the effectiveness and necessity of intercostal nerve repair from the angle of diaphragm function. Methods 132 female SD rats of grade SPF were randomly divided into 4 groups. The left side of the experimental group was in the neck group, and the phrenic nerve (PN) and the accessory phrenic nerve (APN) were cut off in the neck and B group. At the same time when PN and APN were cut off, the 3,4 intercostal nerve (ICN) motor branch was used to repair the distal PN of the neck, and the C group severed the 3,4ICN motor branch at the same time of cutting off PN and APN, and the D group was the control group. The physiological, electrophysiologic and histopathological tests were carried out in 1,2,4,8,12,24W after the operation. Results 1. the internal pressure of the esophagus (Peso) and the internal pressure of the esophagus (Peso) were in the same period of calm respiration. There was no significant difference in Peso between each time point after EMG. of the diaphragm. The EMG activity in the healthy side of the healthy side was larger than that of the group D (P0.05) in the group of EMG:A, B, and C, and there was no significant difference between the D group and the D group. There was no significant difference between the.2. rats and the D group. There was no significant difference in the EMG spectrum analysis of the.3. healthy phrenic muscle at each time point in each time point of the Peso and the healthy side of the diaphragm. There was no significant difference between the high / low frequency ratio (H/L) at all time points after the operation (P0.05). The central frequency (Fc) had no difference between groups at the postoperative 1,2W. 12WA, B, C group B, D group (P0.05), 24WA, C group B, D group (P0.05).4. diaphragmatic muscle after operation. Section area. Affected side: there was no difference between 1,2W groups after operation, after operation 4W, A, B, group C D (P0.05), 8,12,24W, A, C B, D group and healthy side after operation without significant difference; after operation, there was no significant difference between each group after the operation. The number of medullary nerve fibers was.A, no myelinated nerve fibers were found in group C. The number of myelinated nerve fibers in group 4,8,12,24W and B was less than that in group D (P0.05). Conclusion 1. unilateral diaphragmatic paralysis still can produce normal intrapleural pressure in calm respiration. No fatigue.2. phrenic nerve and 2 intercostal nerves are displaced to repair brachial plexus nerve injury in the healthy side of the contralateral diaphragm. Respiratory system decompensation. 3. Compared with unilateral diaphragmatic paralysis without repairing the phrenic nerve, intercostal nerve has no obvious functional advantage in repairing the phrenic nerve.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R565.3
本文编号：2173326
[Abstract]:The first part of the rat phrenic paralysis model was established to observe the anatomical observation of the accessory phrenic nerve in rats. The anatomical position of the accessory phrenic nerve (APN) in the neck of the rat was observed and the location of the APN was found. Methods 28 female SD rats were treated with bilateral phrenic nerve (PN) and the accessory phrenic nerve (APN) in the neck. The occurrence rate of APN was recorded and the location of the rat was recorded. The diameter of PN and APN and the distance between PN and APN at the level of C7 nerve root were measured respectively. Results the occurrence rate of APN was 91.1%, of which the left side was 92.8%, the right 89.3%. originated from the C6 nerve root, the upper trunk, the anterior femoral root, and the upper trunk 9.8%, 23.53%, 49.02%, and all APN of the 17.65%. were issued by the brachial plexus. In the same direction of the brachial plexus, they walked independently to the lower or lower direction of the PN, and entered the upper thoracic cavity on the outside of the PN. In the process of downlink, APN walked in front of C7, middle and outer 1/3 accounted for 54.9%, 23.53%, 21.57%.APN diameter 0.14 + 0.01mm (0.09-0.18mm), about PN diameter (0.32 + 0.02mm) (0.21 ~ 0.43mm) 44%. across C 7 the average distance between APN and PN was 0.36 + 0.06mm (0 ~ 1.64mm) in front of the nerve root. Conclusion the incidence of parphial nerve in the 1. rats is higher than that of the phrenic nerve. It can originate from the C6 nerve root, up the trunk, the femoral root and the upper trunk before the upper trunk, and go along the brachial plexus to the thoracic cavity and enter the thoracic cavity to the outside of the phrenic nerve, with the C6 nerve root and up to the upper trunk. The establishment and evaluation of unilateral diaphragm paralysis model in two rats was established and evaluated by cutting the phrenic nerve (PN) and accessory phrenic nerve (APN) in the neck to establish the rat unilateral diaphragm paralysis model, and the model was evaluated. Methods 24 female SD rats were randomly divided into 3 groups. The left side was real. The diaphragmatic muscles were divided into 5 parts: the sternum (st), the anterior rib (an), the middle rib (MID), the posterior rib (PO) and the waist (1U). Before the experimental treatment, the EMG was taken as the baseline control. The animal model was made: the A group: the neck severed PN and APN; the B group: only the PN; the C group: the control group was finished. After 30min, the lung function, the general observation of the diaphragm and the electrophysiological activities and the phrenic muscle in different parts of the two sides and the phrenic nerve were detected by histopathology. Results after 1., the diaphragmatic muscles of each part of the side of the 30min:A group were completely paralyzed, without visible contraction, without EMG, and the EMG activity of the contralateral diaphragmatic muscle was obviously enhanced. B group suffered from incomplete paralysis of the phrenic muscle, EMG st, an disappeared, EMGpo, Lu existed, and the activity of the contralateral diaphragm muscle activity also enhanced the tidal volume of 4W:A group (TV) after.2. operation (TV) was significantly smaller than B, C group (P0.05), but there was no significant difference in all parameters of lung function between the groups. The scope of arthralgia narrowed, the range of EMG was increased. The number of myelinated nerve fibers in the phrenic nerve before entering the muscle was B, and the group C was 78 + 13 and 447 + 56 respectively. There was a significant difference (P0.05), while the A group had no myelinated nerve fibers. The average cross-sectional area of the phrenic muscle fiber in the affected side of the affected side was smaller than that of the C group (P0.05); and the only sternal part (st) was smaller than the C group (P0.05) (P0.05) in the B group. There was no difference between the other parts of the group) and the other parts were not different from that in the C group. Conclusion using the method of severing the phrenic and accessory phrenic nerve in the neck can make a reliable model of unilateral diaphragm paralysis in rats. Electrophysiologic activity and the diaphragmatic muscles of different parts of the two sides and the pathological examination of the phrenic nerve before entering the muscle. The second part of unilateral diaphragm paralysis has the function of pulmonary function in rats. Objective to evaluate the effect of unilateral diaphragmatic paralysis on the resting and postoperative pulmonary function in rats. The safety of phrenic nerve transfer or 2 intercostal nerve transposition for repair of brachial plexus injury, and the necessity and effectiveness of repairing the phrenic nerve were investigated from the point of view of the lung function. Methods 132 female SD rats were randomly divided into 4 groups. In the lateral.A group, the phrenic nerve (PN) and the accessory phrenic nerve (APN) were cut off in the neck. Group B was used to repair the distal end of the neck with the motor branch of the intercostal nerve (ICN), while PN and APN were cut off, while the C group was cut off PN, and the APN was at the same time. Results the PIF of A, B, C in group C was significantly less than that of group D (P0.05) (A, B, C group), and there were no significant differences between the other parameters of A, B, C group. Obviously less than group D (P0.05), Ti was significantly greater than group D (P0.05), and there was no significant difference between MV and D group in group A after 12 to 15min (P0.05), while F and Ti still had significant differences. 0.05) 0.05. Conclusion 1. unilateral diaphragmatic paralysis has a certain degree of sustained damage to resting lung function (mainly reduced), but it does not affect the volume of ventilation and the early stage of respiratory mode.2. unilateral diaphragm paralysis. There is a decrease of ventilation in the middle intensity aerobic exercise and the prolonged recovery period after exercise, and it can be gradually recovered after the exercise. The ability to exercise high intensity is not clear. The effect of.3. phrenic nerve with 2 intercostal nerve injuries does not further affect the pulmonary function. Both the two simultaneous displacement repair of the brachial plexus injury is a safe.4. intercostal nerve repair of the phrenic nerve after the phrenic nerve repair and the pulmonary function after the unilateral diaphragm paralysis does not repair the phrenic nerve after the unilateral diaphragm paralysis. The third part of unilateral diaphragm paralysis in rats Objective to evaluate the effect of diaphragmatic function on the function of diaphragmatic muscle in rats and to explore the effectiveness and necessity of intercostal nerve repair from the angle of diaphragm function. Methods 132 female SD rats of grade SPF were randomly divided into 4 groups. The left side of the experimental group was in the neck group, and the phrenic nerve (PN) and the accessory phrenic nerve (APN) were cut off in the neck and B group. At the same time when PN and APN were cut off, the 3,4 intercostal nerve (ICN) motor branch was used to repair the distal PN of the neck, and the C group severed the 3,4ICN motor branch at the same time of cutting off PN and APN, and the D group was the control group. The physiological, electrophysiologic and histopathological tests were carried out in 1,2,4,8,12,24W after the operation. Results 1. the internal pressure of the esophagus (Peso) and the internal pressure of the esophagus (Peso) were in the same period of calm respiration. There was no significant difference in Peso between each time point after EMG. of the diaphragm. The EMG activity in the healthy side of the healthy side was larger than that of the group D (P0.05) in the group of EMG:A, B, and C, and there was no significant difference between the D group and the D group. There was no significant difference between the.2. rats and the D group. There was no significant difference in the EMG spectrum analysis of the.3. healthy phrenic muscle at each time point in each time point of the Peso and the healthy side of the diaphragm. There was no significant difference between the high / low frequency ratio (H/L) at all time points after the operation (P0.05). The central frequency (Fc) had no difference between groups at the postoperative 1,2W. 12WA, B, C group B, D group (P0.05), 24WA, C group B, D group (P0.05).4. diaphragmatic muscle after operation. Section area. Affected side: there was no difference between 1,2W groups after operation, after operation 4W, A, B, group C D (P0.05), 8,12,24W, A, C B, D group and healthy side after operation without significant difference; after operation, there was no significant difference between each group after the operation. The number of medullary nerve fibers was.A, no myelinated nerve fibers were found in group C. The number of myelinated nerve fibers in group 4,8,12,24W and B was less than that in group D (P0.05). Conclusion 1. unilateral diaphragmatic paralysis still can produce normal intrapleural pressure in calm respiration. No fatigue.2. phrenic nerve and 2 intercostal nerves are displaced to repair brachial plexus nerve injury in the healthy side of the contralateral diaphragm. Respiratory system decompensation. 3. Compared with unilateral diaphragmatic paralysis without repairing the phrenic nerve, intercostal nerve has no obvious functional advantage in repairing the phrenic nerve.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R565.3
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