幼鼠脊髓损伤致神经源性膀胱模型的建立及尿动力学评估

发布时间：2018-02-20 21:39

本文关键词： 神经源性膀胱脊髓损伤影像尿动力学逼尿肌漏尿点压　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景和目的神经源性膀胱（Neurogenic Bladder,NB）是泌尿外科常见的疾病。是由于控制神经出现紊乱导致的下尿路功能障碍，诊断的标准必须存在神经病变[1]。NB为泌尿系统疾病中治疗最复杂困难的临床病症，无论是发病机制还是临床治疗，仍然有很多问题需要我们解决。因此有必要对其深入研究。但是，鉴于医学伦理及其它原因，很多研究无法在患者身上直接进行，建立动物模型进行相关研究就具有重要意义。NB动物模型的建立多数选择脊髓损伤法或脊髓横断法，主要是造成神经源性改变（主要以下尿路症状为主），脊髓横断造模的方法与Allen's打击脊髓损伤的造模方法相比较缺点在于手术操作复杂，出血量大、不可重复操作。据报道，Allen's重物坠落打击伤动物模型能较好地模拟人类脊髓冲击损伤的特点[2]。本研究采用此简易的脊髓损伤模型方法，拟建立神经源性膀胱的动物模型并进行影像尿动力学评估，探讨一种安全稳定性强、快速简便，重复性好的高位神经损伤模型的制作方法，为临床研究逼尿肌无收缩等神经源性膀胱的病理生理提供一定参考。研究对象和方法雌性清洁级Wistar大鼠22只(河南省实验动物中心提供，年龄4-6周，体量（200±20）g)，实验分组：NB组（n=14）；对照组（假手术组，n=8）。术前1周置笼中喂养，使其熟悉环境后对2组大鼠进行BBB运动功能评估，观察者(非实验小组成员)将大鼠抓于试验台之上，等大鼠待其适应后开始独立观察10分钟。NB组采用改良的Allen's法，以T12为中心，背部正中纵切口，显露T11~T13棘突及椎板，咬除该节段棘突及椎板，，暴露相应脊髓段作为损伤区，先于硬膜上方放置一块矩形的塑料垫片(0．4mm×0．3mm)，再采用Allen's WD法用5g砝码在高度10cm(致伤的定量单位[5]：5g×10cm＝50gcm)处，砝码柄端向下经导管垂直下落，定位定量的打击大鼠脊髓，建立脊髓损伤模型。正常对照组手术操作如上，但仅咬除棘突后即逐层关闭切口。术后对NB组和假手术组进行BBB运动动能评估，之后观察对照组与NB组术后5-6天神经损害的表现并进行影像尿动力学评估。采SPSS17.0统计软件包进行统计分析。计量资料以x±s描述，两组样本均数比较采用独立样本t检验。检验水准设为0.05，P0.05认为差异有统计学意义。结果NB组及对照组Wistar大鼠术后均出现躯干柔软对外界刺激反应小、不饮食。 NB组大鼠术后出现后肢行走时处于拖动状态，安静，呼吸急促。术后2-6d NB组（n=14）始终表现为双后肢及尾部不能活动。假手术组未出现以上神经损伤的改变。NB组与假手术组比较BBB评分，有显著差异，有统计学意义（P0.05）。NB组脊髓损伤的大鼠均出现尿潴留和不同程度排尿困难,术后5-6d影像尿动力学检查显示膀胱体积逐渐增大，成典型的“橄榄球”状，对照组膀胱影像学图像示膀胱体积无明显增加。和对照组相比影像尿动力示NB组逼尿肌无收缩，膀胱最大容量（Maximum bladder capacity, MBC）和膀胱顺应性显著增加(Bladder compliance, BC)，逼尿肌漏尿点压(Leak detrusor pressur, LDP)显著升高（MBC:3.93±2.03ml vs.0.081±0.247ml,P 0.001; BC:0.093±0.54vs.0.022±0.01, P 0.001;LDP:45.38±12.52vs.26±3.85, P 0.001）。结论采用改良的Allen's法（冲击损伤法50gcm）能建立幼鼠高位脊髓损伤NB模型，可以为临床提供参考。
[Abstract]:Background and Objective Neurogenic bladder ( NB ) is a common disease in urology . NB is the most difficult clinical condition in the treatment of urinary system diseases , whether the pathogenesis is the pathogenesis or clinical treatment , there are still many problems that need to be solved . However , in view of the medical ethics and other reasons , many researches cannot be carried out directly on the patient , and it is important to establish animal models . This study uses this simple model of spinal cord injury to establish animal model of neurogenic bladder and to carry out the dynamic assessment of imaging urodynamics , and to explore a method of making high - order nerve injury model with strong safety stability , rapid and simple and good repeatability , which provides a reference for the clinical study of the pathological physiology of the neurogenic bladder such as non - contraction of urinary muscle . The subjects and methods were studied in 22 Wistar rats ( experimental animal center in Henan Province , age 4 - 6 weeks , mass ( 200 卤 20 ) g ) , experimental group : NB group ( n = 14 ) ; control group ( sham operation group , n = 8 ) . The spinal cord injury of rats was assessed by means of modified Allen ' s method , and the spinal cord injury model was established by using modified Allen ' s method . Results All Wistar rats in NB group and control group had soft trunk soft to external stimuli after operation , and did not eat diet . Compared with the control group , there was no significant difference in bladder volume , the maximal bladder capacity ( MBC ) and bladder compliance were significantly increased ( P 0.001 ; BC : 0.093 卤 0.54 vs . 022 卤 0.01 , P 0.001 ; LDP : 45.38 卤 12.52 vs . 26 卤 3.85 , P 0.001 ) . Conclusion The modified Allen ' s method ( 50gcm damage method ) can establish NB model of high spinal cord injury in young rats , which can provide reference for clinic .

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R-332;R694.5

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