發(fā)布時間：2018-04-11 03:10

  本文選題：低強(qiáng)度超聲 + 子宮復(fù)舊　； 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 1.觀察低強(qiáng)度超聲對早孕藥流子宮的收縮作用，分析其對子宮復(fù)舊的影響。 2.探討低強(qiáng)度超聲促進(jìn)早孕大鼠藥物流產(chǎn)后子宮復(fù)舊的可能機(jī)制，為低強(qiáng)度超聲促進(jìn)產(chǎn)后子宮復(fù)舊提供理論依據(jù)。1 方法 1.隨機(jī)選擇3月齡以內(nèi)的雌性普通級遠(yuǎn)交群大鼠（SpragueDawley，SD）55只，雄性普通級SD大鼠5只，按照雌雄2:1的比例夜晚（20:00）合籠，12小時后（次日8:00）觀察陰道栓，然后進(jìn)行陰道涂片于顯微鏡下觀察精子。以顯微鏡發(fā)現(xiàn)精子或明確查見陰道栓的當(dāng)天為妊娠第1天。若未發(fā)現(xiàn)，雌雄大鼠分籠喂養(yǎng)7天后，按前法再次合籠至妊娠，妊娠第7天，依次灌胃米非司酮16.6mg/kg（8:00）與米索前列醇0.1mg/kg（18:00），建立30只大鼠早孕藥物完全流產(chǎn)模型。 2.將建模成功的30只大鼠采用完全隨機(jī)分組法分組到超聲輻照組和假輻照組各15只，超聲輻照組：藥流后第一天開始，使用超聲波子宮復(fù)舊儀照射子宮覆蓋區(qū)域（聲強(qiáng)=2W/cm2，頻率=0.8MHz）。每日1次，每次30分鐘，連續(xù)5天；假輻照組：從藥流后第一天開始使用超聲波子宮復(fù)舊儀照射子宮覆蓋區(qū)域（聲強(qiáng)=0W/cm2，頻率=0MHz）。每日1次，每次30分鐘，連續(xù)5天。 3.孕囊排出后，用眼科鑷于大鼠陰道內(nèi)置入定量棉球一個，每2~6小時取出血棉，檢測其出血量，并記錄出血時間。 4.治療完成后次日，取大鼠左側(cè)子宮組織黃豆大小3塊，采用酶聯(lián)免疫吸附法（ELISA）、化學(xué)檢測法、免疫組織化學(xué)法（IHC）分別檢測內(nèi)皮素-1（endothelin-1，ET-1）、一氧化氮（nitrogen monoxide，NO）和縮宮素受體（oxytocin receptor，OTR）。 結(jié)果 1.受孕成功率為41.7%（40/96）。三種檢查方法，靈敏度陰栓+精子檢查（0.9000）最高，與精子檢查（0.8750）相差不大，陰栓檢查靈敏度（0.7000）最低，特異度三種方法相差不大；陰栓檢查假陰性率高達(dá)30.00%，與精子檢查（12.50%）和聯(lián)合檢查相比（10.00%）差異均有統(tǒng)計學(xué)意義（*P＜0.05），三種檢測受孕方法比較假陽性率無顯著性差異（P＞0.05）。藥物流產(chǎn)成功率為88.24%（30/34）。 2.肉眼觀：假輻照組，子宮已不見孕囊窩，但較正常大鼠子宮粗約2mm~3mm，表面充血明顯，呈櫻紅色；超聲輻照組，大鼠子宮大體觀已基本恢復(fù)至未孕狀態(tài)。病理：超聲輻照組，子宮肌纖維細(xì)長，排列規(guī)則，內(nèi)環(huán)外縱；假輻照組，子宮肌纖維輕度增生肥大，排列稍紊亂，子宮肌層整體較超聲輻照組厚，子宮腔較大。 3.陰道出血量、出血時間的比較，超聲輻照組的大鼠陰道出血量明顯少于假輻照組，差異有統(tǒng)計學(xué)意義（*P＜0.05）；但陰道出血時間超聲輻照組和假輻照組之間沒有顯著性差異（P＞0.05） 4.超聲輻照組的大鼠子宮組織勻漿中ET-1的含量明顯高于假輻照組，具有顯著的統(tǒng)計學(xué)意義（*P＜0.05），，而超聲輻照組大鼠子宮勻漿中NO的含量較低，但沒有明顯的統(tǒng)計學(xué)意義（P＞0.05）。 5.超聲輻照組OTR表達(dá)多為強(qiáng)陽性，假輻照組OTR表達(dá)多數(shù)為弱陽性；無論子宮肌層還是內(nèi)膜層超聲輻照組強(qiáng)陽性表達(dá)率均高于假輻照組，且差異均有顯著統(tǒng)計學(xué)意義（*P＜0.05）。 結(jié)論 1.精子檢查法操作簡便，方法易于掌握，靈敏度高，為最佳的判斷大鼠雌鼠受孕的方法；米非司酮16.6mg/kg＋米索前列醇0.1mg/kg劑量組建立完全藥流模型成功率高，可有效的運用于大鼠完全流產(chǎn)模型的建立。 2.聲強(qiáng)=2W/cm2，頻率=0.8MHz的低強(qiáng)度超聲作用于大鼠完全流產(chǎn)子宮，可促進(jìn)早孕大鼠流產(chǎn)后的子宮復(fù)舊。 3.增加子宮組織ET-1的含量，對ET-1和NO平衡的調(diào)節(jié)可能是低強(qiáng)度超聲促進(jìn)子宮收縮的重要途徑之一。 4.低強(qiáng)度超聲促進(jìn)子宮平滑肌收縮的機(jī)制與增加子宮肌和內(nèi)膜細(xì)胞的OTR表達(dá)有關(guān)。
[Abstract]:objective
1. to observe the contraction effect of low intensity ultrasound on uterine pregnancy abortion, analyzes its influence on uterine involution.
2. to explore the mechanism of low intensity ultrasound can promote uterine involution in early pregnancy rats after drug abortion, and provide a theoretical basis for the.1 of low intensity ultrasound in promoting postpartum uterine involution
Method
The female general level within 1. randomly selected 3 month old outbred rats (SpragueDawley, SD) 55, male SD 5 rats, according to the proportion of male and female 2:1 night (20:00) cage, after 12 hour (8:00 the next day) to observe vaginal suppository, and vaginal smear under a microscope to observe sperm. In order to find microscope sperm or definitely check the day to see vaginal suppository for pregnancy first days. If not found, male and female rats were divided into the cage for 7 days, according to the law again before cage to pregnancy, pregnancy seventh days, followed by intragastric administration of mifepristone and misoprostol 0.1mg/ 16.6mg/kg (8:00) kg (18:00), established in 30 rats early pregnancy abortion model completely.
30 rats 2. successful modeling were randomly grouped into ultrasound group and sham irradiation group with 15 rats in each group, ultrasound group: the first day after medical abortion, the use of ultrasonic irradiation of uterine involution of uterus coverage area (intensity of =2W/cm2, frequency =0.8MHz). 1 times a day, every 30 minutes, continuous 5 days; sham irradiation group: from the first day of the medical abortion after the start of the use of ultrasonic irradiation of uterine involution of uterus coverage area (intensity of =0W/cm2, frequency =0MHz). 1 times a day, every 30 minutes, for 5 consecutive days.
After 3. gestation sac was discharged, a quantitative cotton ball was inserted into the vagina of the rat with an eye tweezers. The blood cotton was removed every 2~6 hours, and the amount of bleeding was detected and the bleeding time was recorded.
The 4. day after treatment, the size of soybean left uterine tissue of rats 3, using enzyme-linked immunosorbent assay (ELISA), chemical assay, immunohistochemistry (IHC) were used to detect endothelin -1 (endothelin-1, ET-1), nitric oxide (nitrogen monoxide, NO) and oxytocin receptor (oxytocin receptor, OTR).
Result
The success rate of pregnancy was 41.7% (40/96) 1.. Three methods, the sensitivity of the pessary + sperm examination (0.9000) and the highest sperm examination (0.8750) or less, the vaginal examination (0.7000) the lowest sensitivity, specificity three methods had little difference; vaginal plug the false negative rate is as high as 30%, and sperm check (12.50%) compared with the joint inspection (10%) the differences were statistically significant (*P < 0.05), there was no significant difference between the three methods for detection of pregnancy compared with the false positive rate (P > 0.05). The success rate of drug abortion was 88.24% (30/34).
2. eye view: sham irradiation group, the uterus has not seen the pregnancy sac fossa, but compared with the normal rat uterus about 2mm~3mm thickness, surface congestionsignificantly, was cherry red; ultrasonic irradiation group, rat uterus concept has been basically restored to the nonpregnant state. Pathology: ultrasound irradiation group, uterine muscle fiber slender, regular arrangement the inner ring, outer longitudinal; sham irradiation group, mild uterine muscle fiber hypertrophy, arranged a little disorder. The myometrium overall than the ultrasound group thickness of uterine cavity is larger.
3., compared with vaginal bleeding and bleeding time, the amount of vaginal bleeding in the ultrasonic irradiation group was significantly less than that in the sham irradiation group (*P < 0.05), but there was no significant difference in vaginal bleeding time between the ultrasonic irradiation group and the sham irradiation group (P > 0.05).
4. the content of ET-1 in the uterine tissue homogenate of the ultrasonic irradiation group was significantly higher than that of the sham irradiation group (*P < 0.05), while the content of NO in the uterine homogenate of the ultrasonic irradiation group was lower, but there was no significant statistical difference (P > 0.05).
5., the expression of OTR in ultrasonic irradiation group was strongly positive. Most of the OTR expression in sham irradiated group was weakly positive. The expression of strong positive in ultrasound and irradiation group was higher than that in sham irradiation group, and the difference was statistically significant (*P < 0.05).
conclusion
1. sperm examination method is simple, the method is easy to grasp, high sensitivity, as the best way of female pregnancy rats were assessed by mifepristone misoprostol; 16.6mg/kg + 0.1mg/kg group to establish complete abortion model with high success rate and can be effectively applied to establish the rat model of complete abortion.
2. sound intensity =2W/cm2, low intensity ultrasound frequency =0.8MHz in rat uterus can promote complete abortion, early pregnancy rats after abortion uterine involution.
3. increasing the content of ET-1 in the uterus and regulating the balance of ET-1 and NO may be one of the important ways to promote the contraction of the uterus by low intensity ultrasound.
4. the mechanism of promoting contraction of uterine smooth muscle by low intensity ultrasound is related to the increase of OTR expression in the endometrium and endometrium cells.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R714.63

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