犬撞击性脊髓损伤急性期脊髓血流变化的初步研究

发布时间：2018-03-04 11:44

  本文选题：犬　切入点：脊髓损伤　出处：《大连医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究目的:急性脊髓损伤(Spinal Cord Injury,SCI)是急诊创伤常见的高致残疾病之一。目前脊髓损伤的急诊室处理集中关注在生命支持、脊柱的固定及防止二次损伤。但大量文献表明这些处理并不能降低SCI患者的致残率,并提出这与撞击性SCI脊髓的继发性损伤密切相关。SCI的继发性损伤是脊髓中央灰质出血、脊髓血流锐减及缺血再灌注损伤导致神经元细胞水肿、脂质过氧化、自由基的形成、细胞膜溶解和炎症等级联反应,最终细胞凋亡或坏死。脊髓血流(Spinal Cord Blood Flow,SCBF)的变化是参与SCI继发性损伤的重要因素之一,所以研究脊髓血流变化是研究SCI的病理生理机制的重要部分。脊髓结构中央主要为神经元细胞构成的蝶形灰质区和四周被有髓纤维细胞构成的白质区。目前SCBF的监测方法常用监测探头位于脊髓表面,实时分区域的血流监测还没见报道,灰质与白质不同区域的血流在撞击性SCI后的变化规律还不十分清楚。因此本课题针对SCBF监测方法的不足,利用针刺式探头激光多普勒血流监测仪(Needle Probe—Laser Doppler Flowmetry,NP—LDF)监测犬撞击性SCI急性期脊髓不同区域的SCBF,初步观察其在SCI后的灰质与白质不同区域变化规律,为进一步了解其病理机制及临床救治提供初步理论依据。实验方法:8只比格犬根据随机数字表法随机分为对照组2只,SCI组6只。对照组只去除犬胸12-胸13(T12-T13)节段脊髓后方结构暴露脊髓,不进行撞击损伤;SCI组去除犬T12-T13脊髓后方结构并利用数控电机撞击装置进行脊髓损伤造模。SCI组动物使用NP—LDF分别于脊髓暴露时,SCI后第5min,第60min,第7 d,第3 w,对照组动物与SCI组动物对应时间对脊髓损伤处中央灰质区、腹侧白质区及背侧白质区血流进行监测;两组动物术后第1d,第7d,第3w进行神经电生理检测:体感诱发电位(Somatosensory Evoked Potentials,SEP)和运动诱发电位(Motor Evoked Potentials,MEP),并利用TSCIS法评估犬后肢行为学功能。SCI组动物分别于术后第7d、第3w随机选取3只处死,取标本进行组织病理学观察。实验结果:1.SCI组所有动物造模成功并进入实验;2.SCBF值:两组动物在脊髓暴露时中央灰质基础值与腹侧白质基础值、背侧白质基础值差异均有统计学意义(P0.05);腹侧白质基础值与背侧白质基础值差异无统计学意义(P0.05);SCI组与对照组脊髓各区域SCBF值在术后各相应时间节点比较差异均有统计学意义(P0.05);SCI组中央灰质区、腹侧白质区及背侧白质区:SCI后第5min与SCI后第60 min、第7 d、第3 w SCBF值比较及术后第60min与术后第7d、第3w SCBF值比较差异均有统计学意义(P0.05),SCI后第7d与第3w比较差异无统计学意义(P0.05);SCI后第5min、第60min、第7d、第3w与脊髓暴露时比较差异均有统计学意义(P0.05)。3.TSCIS评分:对照组动物术后第1d、第7d、3w评分均为20分;SCI组中SCI后第1 d均值为0分、第7 d、第3 w TSCIS值均为0.33±0.52分,差异均无统计学意义(P0.05);与对照组比较差异均有统计学意义(P0.05);4.神经电生理监测:MEP及SEP在SCI各时间点均未发现任何波动记录,双后肢逐渐挛缩,仅靠前肢活动。5.组织学:SCI后第7d病理切片示:脊髓部分失去正常组织,中央灰质坏死,囊腔形成;SCI后第3 w病理切片示:脊髓完全失去正常组织,灰质与白质未见明显界限,多囊腔中出现胶质细胞。实验结论:1.NP—LDF能够精确地测量脊髓中央灰质、腹侧白质、背侧白质的血流;2.脊髓中央灰质、腹侧白质、背侧白质的血流在撞击性SCI后短暂上升然后随着时间变化迅速下降,最后到达稳定。说明SCI继发性损伤在原发性损伤后随之而来;3.本实验中使用NP-LDF刺入脊髓对SCBF进行监测,虽然为有创监测手段,但在课题研究显示探头刺入脊髓对脊髓功能是没有影响的,且能更为准确地反映SCI后脊髓血供的变化。
[Abstract]:Objective: To study the acute spinal cord injury (Spinal Cord, Injury, SCI) is one of the common diseases with high mutilation trauma. The spinal cord injury treatment in the emergency room focus on life support and fixation of the spine and prevent the two damage. But a large number of literatures show that the treatment does not reduce the rate of disability in patients with SCI, and put forward the secondary the secondary injury of spinal cord injury and the impact of SCI.SCI is closely related to the central gray matter of spinal cord hemorrhage, spinal cord blood flow decreased and ischemia reperfusion injury lead to neuronal cell edema, lipid peroxidation, free radical formation, cell membrane dissolution and the grade of inflammation cascade reaction, the final cell apoptosis or necrosis of spinal cord blood flow (Spinal Cord Blood. Flow, SCBF) change is one of the important factors involved in secondary injury of SCI, so the study of spinal cord blood flow change is an important part of the research on the pathophysiological mechanism of SCI. The structure of spinal cord The central main neurons of a butterfly shaped region surrounded by a gray and white matter regions constitute medullary fiber cells. The monitoring method of SCBF common monitoring probe is positioned on the surface of spinal cord blood flow monitoring, real time region has not been reported. The variation of gray matter and white matter in different regions of the blood flow in the SCI after the crash not very clear. Therefore the issue for SCBF monitoring method, using needle type probe of laser Doppler flowmetry (Needle Probe - Laser Doppler Flowmetry, NP LDF) monitoring dog impact SCI acute spinal cord in different regions of the SCBF, to observe its changes in different regions after SCI provides gray matter and white matter. A preliminary theoretical basis for further understanding of the pathogenesis and clinical treatment. Methods: 8 beagle dogs according to randomly divided into control group 2, SCI group 6. Control group only removal Chest 12- chest 13 (T12-T13) structure of spinal cord posterior exposed spinal cord, without impact damage; group SCI removal of canine T12-T13 spinal cord posterior structure and the use of CNC electric percussion device for a spinal cord injury animal model group.SCI using NP - LDF in the spinal cord were exposed after SCI, 5min, 60min, D seventh. Third w control group and SCI group of animal animal injury at the corresponding time central gray area of spinal cord, ventral and dorsal white matter white matter blood flow monitoring; animal operation in two groups after 1D, 7d, 3W for electrophysiological examination: somatosensory evoked potential (Somatosensory Evoked Potentials, SEP motor evoked potentials (Motor) and Evoked Potentials, MEP), and to evaluate the canine hindlimb behavior.SCI group animal respectively after 7d using the TSCIS method, the 3W randomly selected 3 rats, specimens were taken for histopathological observation. Results: in group 1.SCI, all animal 妯℃垚鍔熷苟杩涘叆瀹為獙;2.SCBF鍊，

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