本文選題：應激　切入點：腦損害　出處：《蚌埠醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：【背景與目的】:燒傷是國內(nèi)外常見的一種意外創(chuàng)傷,雖然當今精湛的醫(yī)療技術水平已大大降低了燒傷患者的死亡率,但燒傷患者還極易出現(xiàn)持續(xù)而強烈的應激反應,從而導致一些系統(tǒng)相關的應激性損害。其中大腦作為產(chǎn)生感覺、控制運動及完成各種高級腦功能的高級神經(jīng)中樞,應激反應引起的腦損害所帶來的危害尤為突出。目前,關于嚴重燒傷早期應激性腦損害動物模型進行的研究較少。本研究在建立燒傷早期腦損害大鼠模型的基礎上,應用磁共振T2加權成像(T2 weighted imaging,T2WI)、彌散加權成像(diffusion weighted imaging,DWI)及彌散張量成像(diffusion tensor imaging,DTI)技術,并結(jié)合病理學檢查,檢測在不同時間點(3h、6h、12h、18h、24h、48h、72h)嚴重燒傷早期應激性腦損害動物模型的腦組織特征,旨在闡明燒傷早期腦損害的影像學變化規(guī)律,并跟病理學結(jié)果進行對照分析研究。【材料與方法】:實驗選取40只SD雄性大鼠(280±31.8g)進行實驗,隨機分為正常對照組和不同時間點(3h、6h、12h、18h、24h、48h、72h)燒傷模型組,共8組,每組5只。在大鼠清醒狀態(tài)下,建立燒傷應激模型。分別于燒傷后不同時間點使用磁共振(德國SIEMENS Skyra 3.0T超導MR掃描儀)及大鼠腦專用線圈(上海辰光醫(yī)療科技有限公司),行T2WI序列、DWI序列及DTI序列掃描。采用SIEMENS公司提供的Syngo.via軟件,觀察T2WI、DWI、DTI序列的圖像,并對其進行后處理,分別測量不同時間點大鼠腦不同部位(雙側(cè)對稱頂葉皮層、額葉皮層、尾狀核)的T2WI信號強度(signal intensity,SI)值、表觀彌散系數(shù)(apparent diffusion coefficient,ADC)及各向異性指數(shù)(fractional anisotropy,FA)。各組大鼠行磁共振掃描后于麻醉狀態(tài)下迅速取腦組織,對相應部位行病理學檢查。然后對整體數(shù)據(jù)進行正態(tài)分布性檢驗證實為正態(tài)分布后,組間比較應用單因素方差分析,用SPSS22.0統(tǒng)計學軟件對所測值行獨立樣本t檢驗,比較不同部位T2WI SI值、FA值和ADC值在不同時間點是否存在顯著性差異,P0.05為差異有統(tǒng)計學意義,并對影像學與病理學結(jié)果進行對比分析�！窘Y(jié)果】:1.同組不同部位T2WI SI值、FA值和ADC值在雙側(cè)大腦半球間均未見統(tǒng)計學差異。2.不同部位ADC值:燒傷組不同部位與對照組相比,燒傷后3小時組ADC值未見統(tǒng)計學差異,燒傷后6小時組額頂葉皮層ADC值較對照組降低,于24小時組達最低值,48小時組及72小時組ADC值有升高趨勢,但仍低于正常對照組;尾狀核ADC值于12小時組才發(fā)現(xiàn)有降低趨勢,之后變化趨勢與額頂葉皮層相似,差異有統(tǒng)計學意義。3.不同部位T2WI SI值:燒傷組不同部位與對照組相比,燒傷后各部位3小時到12小時組T2WI SI值未見明顯差異,18小時組及24小時組有上升趨勢,并達最大值,48小時及72小時組有下降趨勢,但仍高于正常組,差異有統(tǒng)計學意義。4.不同部位FA值:燒傷組不同部位與對照組相比,燒傷后各組尾狀核FA值未見明顯統(tǒng)計學差異。燒傷后額頂葉皮層FA值于12小時組發(fā)現(xiàn)較對照組降低,24小時組達最低值,之后逐漸升高,但仍低于正常對照組,差異有統(tǒng)計學意義。5.HE染色:正常對照組除神經(jīng)元和血管周圍有些間隙之外,神經(jīng)細胞形態(tài)正常,分布比較均勻,數(shù)量多而排列規(guī)整,膠質(zhì)細胞無明顯腫脹。燒傷組后6小時組細胞輕度腫脹,血管周圍間隙輕度增寬,隨燒傷后時間延長,各項病變不同程度增多及加重,偶可見局灶性的神經(jīng)元崩解壞死,傷后24小時細胞水腫最明顯,水腫以腦組織周邊部位改變?yōu)橹?48小時及72小時組細胞腫脹程度相對24小時組有所減輕�！窘Y(jié)論】:磁共振DWI、DTI及T2WI技術并結(jié)合病理學檢查可以用來評估大鼠嚴重燒傷應激性腦損害的動態(tài)變化過程,可為臨床燒傷后早期應激性腦損害的早期診斷、干預和治療提供理論依據(jù)和循證支持。
[Abstract]:Background and objective: [] burn is a common accident trauma at home and abroad, although the superb medical technology level has greatly reduced the mortality of burn patients, but also burn patients prone to stress lasting and strong, leading to stress damage of some related systems. The brain as a result of feeling. Senior neural control movement and complete all kinds of advanced brain function damage, brain damage caused by stress response is particularly prominent. At present, a severe burn on early brain injury animal model of stress is less. The research in the establishment of early brain injury in burn rat model based on the application of T2 weighted magnetic resonance imaging (T2 weighted imaging, T2WI), diffusion weighted imaging (diffusion weighted, imaging, DWI) and diffusion tensor imaging (diffusion tensor, imaging, DTI) technology, combined with pathological examination The investigation, detection at different time points (3H, 6h, 12h, 18h, 24h, 48h, 72h) early stress-induced brain injury in animal models of brain tissue characteristics of severe burns, to elucidate the early brain injury, burn the imaging changes and pathological results were compared. [materials and methods] experiment: a total of 40 SD male rats (280 + 31.8g) experiment, were randomly divided into normal control group and different time points (3H, 6h, 12h, 18h, 24h, 48h, 72h) burn group, a total of 8 groups, 5 rats in each group. The rats in the awake state, the establishment of burn stress model. To burn at different time points after using magnetic resonance (Skyra 3.0T superconducting MR Germany SIEMENS scanner) and rat brain coil (Shanghai Chenguang Medical Technology Co Ltd), T2WI sequence, DWI sequence and DTI sequence scanning. By using SIEMENS company's Syngo.via software, T2WI DWI, DTI observation, image sequence, and the For postprocessing, were measured in rats at different time points in different parts of the brain (bilateral parietal cortex, frontal cortex, caudate nucleus) of the signal intensity of T2WI (signal intensity SI) values, apparent diffusion coefficient (apparent diffusion, coefficient, ADC) and anisotropy index (fractional anisotropy, FA). The rats underwent after MRI scan under anesthesia quickly take brain tissue for pathological examination on the corresponding parts. Then the data of normal distribution test confirmed normal distribution after analysis and comparison between groups using one-way ANOVA, independent samples t test value of the measured by SPSS22.0 statistical software, comparison of different parts the T2WI SI value at different time points there is a significant difference between the FA value and ADC value of P0.05, the difference was statistically significant, and the imaging results were compared with pathology. [results]: 1. groups with different parts of the T2WI SI The value of FA and ADC values in the bilateral cerebral hemisphere showed no significant difference between different parts of.2. ADC value in different parts of the burn group compared with the control group, 3 hours group ADC there was no significant difference in value after burn, burn after 6 hours group of frontoparietal cortex ADC values were lower than the control group, 24 hour group was the lowest 48 hours and 72 hours, group group ADC value increased, but still lower than the normal control group; caudate nucleus ADC value in 12 hours group was found to have decreased after the change trend is similar to the parietal cortex, there was a significant difference between the different parts of.3. T2WI SI: burn injury group compared with the control group in different parts and each part of 3 hours to 12 hours after burn group T2WI SI there was no obvious difference, 18 hours group and 24 hours group has a rising trend, and reached the maximum value, 48 hours and 72 hours were decreased, but still higher than the normal group, the difference has statistical significance in different parts of.4. FA Value: different parts of the burn group compared with the control group, each group of caudate nucleus FA no significant difference after burn after burn. The parietal cortex FA value in 12 hours group were lower than the control group, 24 hour group reached the minimum value, then gradually increase, but still lower than the normal control group, the difference was statistically significant.5.HE staining: normal control group except some clearance around neurons and blood vessels, nerve cell morphology of normal distribution is more uniform, the number and arrangement of regular, glial cells had no obvious swelling. The burn group 6 hours after the cells were slightly swollen, perivascular space widened slightly, with prolonged time after burn, the lesions of different degrees of increase. And even worse, visible focal necrotic neurons, 24 hours after injury were the most obvious edema, edema in the peripheral area of brain changes for 48 hours and 72 hours, 24 hours group cell swelling degree Group has been reduced. [Conclusion]: magnetic resonance DWI, the dynamic process of DTI and T2WI technology combined with pathological examination can be used to evaluate the severe burn stress of brain damage in rats, early diagnosis for early clinical stress brain damage after burn injury, intervention and treatment and provide a theoretical basis and evidence-based support.

【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R644;R445.2

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