植入式膈神经刺激器在兔颈脊髓半切损伤模型的应用研究

发布时间：2018-04-02 15:26

本文选题：脊髓半切损伤　切入点：膈神经　出处：《中国脊柱脊髓杂志》2017年02期

【摘要】：目的:应用兔C3脊髓半切损伤模型造成单侧膈肌瘫痪,观测植入式膈神经刺激器对膈肌功能恢复的有效性和组织相容性。方法:30只新西兰大白兔随机分为对照组(A组)和实验组(B组),每组15只,建立兔C3脊髓半切损伤模型造成单侧膈肌瘫痪,并植入膈神经刺激器。B组组每日施加电刺激干预(每日1次,每次8h),A组不施加电刺激干预。两组分别于颈髓损伤前、术后1、2、4周行血气分析检测;术后1、2、4周对膈肌、膈神经进行形态学观察,并对膈肌肌纤维细胞横截面的面积进行统计学分析。结果:颈髓损伤术后1周,两组PaO_2值都下降,PaCO_2都升高,但组间比较无统计学意义(P0.05);术后2周A组PaO_2值开始回升,PaCO_2值无明显变化,B组PaO_2值继续降低,PaCO_2值继续增大,两组间比较存在统计学差异(P0.05);术后4周B组PaO_2值明显升高(未恢复至正常水平),PaCO_2恢复至正常水平,与A组相比存在统计学差异(P0.05)。术后1周两组膈肌细胞横截面积无显著差异(P0.05),术后2周、4周A组膈肌细胞横截面积均较B组组明显减小,与B组存在统计学差异(P0.05)。A组2周时膈肌细胞肌束膜及肌内膜边界不清,4周时局部肌细胞破坏;B组4周时肌细胞肌束膜及肌内膜边界仍清晰。A组术后1周时膈神经结构正常,2周时可见髓鞘增生,鞘索比例增大,数目减少;4周时可见髓鞘异常增生明显,神经间质水肿,微管微丝线粒体大量缺失。B组膈神经始终为正常结构。结论:植入式膈神经刺激器能够促进颈髓损伤后新西兰大白兔膈肌呼吸功能的恢复,其机制可能与膈神经刺激能够延缓颈髓损伤后膈肌萎缩和膈神经变性有关。
[Abstract]:Aim: to observe the effectiveness and histocompatibility of implanted phrenic nerve stimulator on the recovery of diaphragm function in unilateral diaphragmatic paralysis caused by C3 spinal cord hemisection injury in rabbits.Methods Thirty New Zealand white rabbits were randomly divided into control group A (n = 15) and experimental group B (n = 15).Group B was implanted with phrenic nerve stimulator. Group B received electrical stimulation once a day.Before cervical spinal cord injury and 4 weeks after operation, blood gas analysis was performed in the two groups, the diaphragm and phrenic nerve were observed and the cross-sectional area of diaphragm fibroblasts was analyzed statistically.There was statistical difference between the two groups (P 0.05), and the PaO_2 value in group B was significantly higher than that in group A at 4 weeks after operation (no return to normal level) and there was a statistical difference between group A and group A (P 0.05).There was no significant difference in diaphragm cell cross-sectional area between the two groups at 1 week after operation (P 0.05), but at 2 weeks and 4 weeks after operation, the diaphragm cell cross-sectional area in group A was significantly smaller than that in group B.There is a statistical difference between group B and group P0.05. Group A: at 2 weeks after operation, the diaphragm myobiliary membrane and the boundary of the muscle endomembrane are unclear. In group B, the myocyte bundles and the boundary of the endomyocytes are still clear at 4 weeks after operation. The phrenic nerve in group A is still clear at 1 week after operation.Myelin proliferation could be seen at 2 weeks after normal structure.The proportion of sheath cord increased, the number of sheath decreased 4 weeks, the myelin sheath was abnormal hyperplasia, the nerve interstitial edema, microtubule microfilament mitochondria large number of missing. B group phrenic nerve is always normal structure.Conclusion: implanted phrenic nerve stimulator can promote the recovery of diaphragm respiratory function after cervical spinal cord injury in New Zealand white rabbits. The mechanism of phrenic nerve stimulation may be related to the delay of diaphragm atrophy and phrenic nerve degeneration after cervical spinal cord injury.
【作者单位】：中国康复研究中心北京博爱医院脊柱脊髓外科;首都医科大学康复医学院;
【基金】：首都卫生发展科研专项课题(编号:2011-6001-01)
【分类号】：R651.2;R-332

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