过氧化氢溶液在清创过程中冲洗时间的长短对周围神经损伤修复的影响

发布时间：2018-04-18 10:39

本文选题：过氧化氢溶液 + 坐骨神经　；参考：《医学研究生学报》2017年02期

【摘要】：目的目前国内外关于过氧化氢溶液(H_2O_2)对周围神经损伤修复的影响研究还相对较少。文中旨在探讨H_2O_2在外科清创过程中冲洗不同的时间对周围神经损伤修复的影响。方法选取雄性新西兰大白兔18只,随机分成等渗盐水组(等渗盐水冲洗)、H_2O_21 min组(H_2O_2冲洗1min+等渗盐水冲洗)、H_2O_23 min组(H_2O_2冲洗3min+等渗盐水冲洗),每组6只。建立兔坐骨神经损伤的动物模型,术后12周处死实验动物,于缝合神经处取材,检测运动神经传导速度,观察病理切片HE染色情况,第8、12周分别测定兔坐骨神经功能指数(SFI)并进行比较。结果 H_2O_21 min组、等渗盐水组神经传导速度[(25.89±1.42)、(26.46±1.67)m/s]较H_2O_23 min组[(23.80±2.91)m/s]升高(P0.05)。病理切片观察可见等渗盐水组鞘膜结构较好;H_2O_21 min组神经纤维结构破坏不明显,髓鞘变性轻;H_2O_23 min组鞘膜结构模糊不清,髓鞘轴突变形明显。术后8周、12周,等渗盐水组SFI[(-43.00±0.82)、(-39.17±0.91)m/s]明显高于H_2O_21 min组[(-49.79±1.47)、(-46.60±0.79)m/s]、H_2O_23 min组[(-51.66±1.27)、(-46.39±0.94)m/s],差异有统计学意义(P0.05)。术后8周H_2O_21 min组SFI明显高于H_2O_23 min组[(-49.79±1.47)m/s vs(-51.66±1.27)m/s,P0.05]。结论 H_2O_2溶液对受损的周围神经损伤修复有影响且随着H_2O_2溶液冲洗时间的延长可加重周围神经的损伤。临床外科清创过程中在保证杀菌的前提下应尽可能缩短H_2O_2的作用时间。
[Abstract]:Objective to study the effect of hydrogen peroxide solution H _ S _ 2O _ 2 on peripheral nerve injury and repair at home and abroad.The purpose of this study was to investigate the effects of different irrigation time on peripheral nerve repair during surgical debridement with H_2O_2.Methods Eighteen male New Zealand white rabbits were randomly divided into two groups (6 in each group) in which H _ 2O _ 2 was used to wash 1min isoosmotic saline solution and H _ 2O _ 2 was used to wash 1min isoosmotic saline water in group H _ 2O _ 2 and H _ 2O _ 2 was used to wash 3min isoosmotic salt water in group H _ 2O _ 2 and H _ 2O _ 2 were used in group H _ 2O _ 2 and S _ 2O _ 2 were divided into two groups.The animal model of sciatic nerve injury in rabbits was established. The experimental animals were killed 12 weeks after operation. The nerve conduction velocity was detected and HE staining was observed in pathological sections.The sciatic nerve function index (SFI) was measured and compared at 812 weeks.Results the nerve conduction velocity (NV) in H_2O_21 min group and isosmotic saline group [25.89 卤1.42 卤2.46 卤1.67)m/s] was significantly higher than that in H_2O_23 min group [23.80 卤2.91)m/s].Histopathological examination showed that the structure of the sheath was better in the isosmotic saline group than in the control group. The nerve fiber structure was not destroyed obviously in the group of H _ 2O _ 21 min, and the structure of the sheath was blurred and the axon deformation of the myelin sheath was obvious in the group of mild myelin degeneration and H _ 2O _ 2O _ 23 min.At the 8th week and 12th week after operation, the SFI in the Isoosmotic saline group was significantly higher than that in the H_2O_21 min group [-49.79 卤1.47 卤1.47, 46.60 卤0.79)m/s] and the H2O23 min group [-51.66 卤1.27-46.39 卤0.94)m/s]. The difference was statistically significant (P 0.05).The SFI of the H_2O_21 min group was significantly higher than that of the H_2O_23 min group at 8 weeks after operation [-49.79 卤1.47)m/s vs(-51.66 卤1.27 m / s P 0.05].Conclusion H_2O_2 solution has an effect on the repair of injured peripheral nerve, and the injury of peripheral nerve can be aggravated with the prolongation of washing time of H_2O_2 solution.In the process of debridement in clinical surgery, the action time of H_2O_2 should be shortened as far as possible on the premise of sterilization.
【作者单位】：桂林医学院附属医院骨科;
【基金】：桂林市科学研究与技术开发计划(20130120-5)
【分类号】：R745

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