大鼠脑损伤和脊髓损伤后TMS-MEP对运动功能的评价及其安全性的研究

发布时间：2018-04-30 05:29

本文选题：临床法医学 + 经颅磁刺激　；参考：《华中科技大学》2013年硕士论文

【摘要】：【研究背景】近年来，随着经济建设及交通运输业的快速发展，颅脑外伤呈明显上升趋势，前期磁刺激对脊髓外伤后TMS-MEP对运功功能的评价进行了实验的探讨，但脑外伤没有明确的模型和实验，经颅磁刺激（Transcranial magnetic stimulation，TMS）在临床上被应用于治疗精神疾病和神经功能障碍取得了一些成果，在法医临床学领域前期试验证实MEP （motor evoked potential， MEP）波幅同BBB（Basso-Beattle-Bresnahan, BBB）[1]评分显著相关。但是，TMS的安全性问题被提出，表现在TMS实验动物本身及产品应用安全性两个主要方面。故本文从TMS对动物安全和影响的评估和非预期效应的评估等二个方面进行了阐述，并对TMS的应用提出建议。以期为法医临床鉴定中将TMS-MEP方法应用于客观肌力的检测的安全性提供实验数据。【目的】观察大鼠脑损伤和脊髓损伤后TMS-MEP波形、潜伏期、波幅及运动功能之间的变化特点，观察大鼠的各项指标，评估其应用的安全性。【材料与方法】1、健康成年SD大鼠60只，重量200~300克，，随机分为正常对照组（10只，其中1只进行病理学观察）、脑损伤组A（重物打击组，10只，其中1只进行病理学观察）、脑损伤组B（TMS刺激组，20只，其中5只进行病理学观察）、脑损伤及脊髓损伤组（20只，其中1只进行病理学观察）。2、各组每天分别经颅在50%、70%、90%磁刺激强度下记录腓肠肌的TMS-MEP。观察实验过程中大鼠的一般行为学表现及试验后大鼠的整体健康和一般健康，每组取6只老鼠检测血液生化指标。3、4周后，对大鼠左下肢腓肠肌TMS-MEP结果进行统计学分析，得出大鼠脑外伤后TMS-MEP与运动功能之间的关系及该检测方法的安全的评价。【结果】（1）大鼠脑外伤后B组与正常对照组MEP潜伏期、波幅无显著性变化（P＞0.05）。（2）脑损伤及脊髓损伤组大鼠MEP波形难以引出。（3）50%、70%、90%刺激强度下，各组MEP潜伏期缩短、波幅增高。（4）脑损伤组A与脑损伤组B血液生化指标无明显改变。（5）脑损伤组B HE染色光镜下无再出血及明显水肿。【结论】1.TMS-MEP可以对中枢性运动功能障碍者肌力进行客观评价。 2.在一定限定条件下、安全范围内经颅磁刺激是一种安全的、无痛的、操作简便的检测方法。
[Abstract]:[background] in recent years, with the rapid development of economic construction and transportation and transportation, craniocerebral trauma has an obvious upward trend. The evaluation of TMS-MEP on the function of transport power after spinal cord injury was studied experimentally by magnetic stimulation in the early stage. However, there are no definite models and experiments for traumatic brain injury. Transcranial magnetic stimulation has been applied to the treatment of mental illness and neurologic dysfunction in clinic. A preliminary study in the field of forensic clinic confirmed that the amplitude of MEP motor evoked potentialwas significantly correlated with BBBBasso-Beattle-Bresnahan (BBB1) score. However, the safety problem of TMS has been put forward, which is manifested in two main aspects: TMS laboratory animal itself and product application safety. In this paper, the assessment of animal safety and effect and the evaluation of unexpected effects of TMS are discussed, and some suggestions on the application of TMS are put forward. In order to provide experimental data for the application of TMS-MEP method in objective muscle strength detection in forensic clinical identification. [objective] to observe the changes of TMS-MEP waveform, latency, amplitude and motor function after brain and spinal cord injury in rats, and to evaluate the safety of its application. [materials and methods] 1. 60 healthy adult SD rats weighing 200,300 g were randomly divided into normal control group (n = 10) and brain injury group (n = 10). One of them was observed by pathology, 20 rats were treated with B(TMS stimulation in brain injury group, 5 of them were observed by pathology, and 20 rats were treated with brain injury and spinal cord injury. Pathological observation was performed on one of them. TMS-MEP of gastrocnemius muscle was recorded in each group under 90% magnetic stimulation. The general behavior of the rats and the overall and general health of the rats after the experiment were observed. The blood biochemical indexes of 6 rats in each group were measured for 4 weeks. The results of TMS-MEP in the gastrocnemius muscle of the left lower extremity of the rats were analyzed statistically. The relationship between TMS-MEP and motor function after traumatic brain injury in rats and the safety evaluation of this method were obtained. [results] 1) there was no significant change in the latency and amplitude of MEP between group B and control group after traumatic brain injury (P > 0.05). 2) the MEP waveform of rats with brain injury and spinal cord injury was difficult to elicit. The latency and amplitude of MEP in each group were shortened and increased under 90% stimulation intensity. 4) there were no significant changes in blood biochemical indexes between brain injury group A and brain injury group B. In the brain injury group, there was no rebleeding and obvious edema under light microscope with HE staining. [conclusion] 1.TMS-MEP can objectively evaluate the muscle strength of patients with central dyskinesia. 2. Transcranial magnetic stimulation (TMS) is a safe, painless and simple method for detection under certain conditions.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：D919.4

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