局麻药物对GM-CSF表达及皮肤愈合的影响

发布时间：2018-05-18 21:34

本文选题：罗哌卡因 + 利多卡因　；参考：《山西医科大学》2014年硕士论文

【摘要】：研究目的：探讨局麻药物局部浸润对GM-CSF(粒细胞-巨噬细胞集落刺激因子)表达及皮肤愈合的影响。研究背景：近年来研究发现局麻药存在新型作用。这些新型的作用属于亦或超出了，临床麻醉及疼痛治疗的范畴，且对局麻药的临床应用和器官，组织功能的影响利弊共存。现已有大量研究结果显示局麻药在全身给药时有明显的抗炎作用。然而在局部给药时，由于组织损伤后固有细胞以及局部神经结构通过神经末梢释放的肽类物质共同参与了局部炎症反应。所以局麻药局部浸润所产生的效应可能与全身应用时所产生的效应完全不同。已有研究证明局麻药可能会影响伤口愈合，但其影响愈合的机制尚不明确。研究内容及方法：采用小鼠全层皮肤损伤模型。经腹腔内麻醉以后，在背部正中线近颈侧建造一个1cm×1cm大小的全层皮肤损伤创面。120只(雄性昆明小鼠)创面造模成功后，采用单笼饲养的方式，依次将每笼编号，分别为1~120号，然后严格按照完全随机原则，将小鼠分为三个大组即：对照组（S组，n=40),0.5%罗哌卡因浸润组（P组，n=40)，0.5%利多卡因浸润组（D组，n=40)。再将每个大组分为五个时相点，分别为8只。S组用0.9%生理盐水0.1ml/12h创面局部浸润，P组用0.5%罗哌卡因0.1ml/12h创面局部浸润，D组用0.5%利多卡因0.1ml/12h创面局部浸润。分别于伤后第3,5,7,10天，切取创面处的组织，采用ELISA法测定创面GM-CSF表达，，并用BCA蛋白定量法检测各个相应标本中总蛋白的含量，用测量所得的ELISA值与与其相应的BCA值之比表示GM-CSF浓度，来进行组间的比较；分别于伤后第5天和第10天取创面组织检测其病理变化；S组，P组，D组各8只小鼠饲养直至创面愈合以观察创面愈合的时间。结果: （1）应用ELISA法测定结果显示：小鼠背部缺损创面造模成功后第3d和第5d，P组和D组小鼠的皮肤损伤创面处的GM-CSF的表达显著高于S组（P0.05)；且P组和D组间比较，其差异具有统计学意义，P组创面处的GM-CSF表达高于D组（P0.05)。（2）病理学结果:术后第5天:间质内有肉芽组织形成。P2组:间质内有毛细血管，较多成纤维细胞，炎细胞减少。D2组：间质内少量成纤维细胞及炎细胞。S2组：间质内肉芽组织极少见，间质仅见少量成纤维细胞。术后第10天，P4组：表面鳞状上皮明显增生增厚，胶原纤维明显增多。D4组：表面鳞状上皮增厚，有呈梭形的胶原纤维。S4组：表面见鳞状上皮增生，另外可见胶原纤维及少量炎细胞浸润于间质内。（3）各实验组的创面愈合时间：对照组创面愈合的时间为（20.75±2.38）d；0.5%罗哌卡因组创面愈合时间为（16.13±1.36）d；0.5%利多卡因组创面愈合时间为（18.25±1.67）d。P组较D组提前（2.13±1.73）d；D组较S组提前（2.50±1.78）d 结论：局部浸润局麻药物可促进创面GM-CSF的表达有利于皮肤的愈合；罗哌卡因的作用优于利多卡因。
[Abstract]:Objective: to investigate the effect of local anesthetic infiltration on the expression of GM-CSFF (granulocyte-macrophage colony stimulating factor) and skin healing. Background: in recent years, local anesthetics have been found to have new effects. These new effects belong to, or go beyond, clinical anaesthesia and pain treatment, and coexist with the clinical application of anesthetic and the effects of organ and tissue functions. A large number of studies have shown that local anesthetics have a significant anti-inflammatory effect when administered throughout the body. However, during local administration, endogenous cells and peptides released by local nerve structures through nerve endings are involved in the local inflammatory reaction due to tissue injury. So the effect of local anesthetic infiltration may be completely different from that of systemic application. Local anesthetic may affect wound healing, but its mechanism is unclear. Contents and methods of the study: The whole skin injury model of mice was used. After intraperitoneal anesthesia, an 1cm 脳 1cm size full-thickness skin injury wound was constructed on the median line of the back near the neck. After successful modeling of the wound, each cage was numbered from 1 to 120 by single cage feeding. Then, according to the principle of complete randomness, the mice were divided into three groups: control group (group S): control group (group S) with 0.5% ropivacaine infiltration group (group P) and group P with 0.5% lidocaine infiltration group (group D). Each large group was divided into five time points: group S was treated with 0.9% normal saline 0.1ml/12h and group P was treated with 0.5% ropivacaine 0.1ml/12h. Group D was treated with 0.5% lidocaine 0.1ml/12h. The tissue of the wound was cut off on the 10th day after injury, and the expression of GM-CSF was measured by ELISA method. The total protein content of each specimen was detected by BCA protein quantitative method. The GM-CSF concentration was expressed by the ratio of the measured ELISA value to the corresponding BCA value. The histopathological changes of wound tissue were detected on the 5th and 10th day after injury. The rats in group S were fed with 8 mice in group P until the wound healed to observe the time of wound healing. Results: 1) the results of ELISA assay showed that the expression of GM-CSF in the wound of skin injury in group P and D was significantly higher than that in group S on the 3rd and 5th day after the model was established, and the expression of GM-CSF in group P and group D was significantly higher than that in group S, and the expression of GM-CSF in group D was significantly higher than that in group P, and the expression of GM-CSF in group D was significantly higher than that in group S. The expression of GM-CSF in the wound surface of P group was significantly higher than that in D group (P 0.05N. 2) pathological results: on the 5th day after operation, there were granulation tissue formation in interstitial tissue. P2 group: there were capillaries and more fibroblasts in interstitial tissue. In group D 2, a small number of fibroblasts were found in the interstitial cells, and only a few fibroblasts were found in the interstitial cells. On the 10th day after operation, in the P4 group: the surface squamous epithelium was thickened obviously, the collagen fiber was obviously increased. D4 group: the surface squamous epithelium thickened, and the spindle collagen fibers were seen in the S4 group: the squamous epithelium proliferation was observed on the surface. In addition, collagen fibers and a small amount of inflammatory cells infiltrated the interstitial stroma.) the wound healing time of each experimental group was 20.75 卤2.38 days of ropivacaine 0.5% ropivacaine group was 16.13 卤1.36 days old and 0.5% lidocaine group wound healing time was 16.13 卤1.36 days. 2. 13 卤1. 73 days in group D and 2. 50 卤1. 78 days earlier in group D than in group S. 18. 25 卤2. 25 卤1. 78 days earlier than group D Conclusion: local anesthetic infiltration can promote the expression of GM-CSF in wound and ropivacaine is superior to lidocaine.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

【相似文献】