單側(cè)膈肌麻痹對呼吸功能影響的實驗研究
發(fā)布時間：2018-08-09 07:18
【摘要】：第一部分大鼠單側(cè)膈肌麻痹模型的建立實驗一大鼠副膈神經(jīng)的解剖觀察目的觀察大鼠頸部副膈神經(jīng)(APN)的解剖位置和走行,探索尋找APN的部位。方法雌性SD大鼠28只,頸部顯露雙側(cè)膈神經(jīng)(PN)和副膈神經(jīng)(APN)。記錄APN的出現(xiàn)率、發(fā)出部位、走行及跨C7前方的相對位置,分別測量PN和APN的直徑、C7神經(jīng)根水平PN與APN之間的距離。結(jié)果APN出現(xiàn)率91.1%,其中左側(cè)92.8%,右側(cè)89.3%。發(fā)自C6神經(jīng)根、上干、上干前股根部、上干前股者分別占9.8%、23.53%、49.02%、17.65%。所有的APN由臂叢神經(jīng)各部位發(fā)出后,均沿臂叢神經(jīng)相同的走行方向獨立走行少許后轉(zhuǎn)向下或內(nèi)下方向,于PN的外側(cè)進入胸廓上口。在下行過程中,APN走行在C7前方內(nèi)、中、外1/3的分別占54.9%、23.53%、21.57%。APN直徑0.14±0.01mm(0.09-0.18mm),約占PN直徑(0.32±0.02mm)(0.21～0.43mm)的44%�？缭紺7神經(jīng)根前方時,APN與PN之間平均相距0.36±0.06mm(0～1.64mm)。結(jié)論1.大鼠副膈神經(jīng)的出現(xiàn)率較高,比膈神經(jīng)細(xì)小,可發(fā)自C6神經(jīng)根、上干、上干前股根部和上干前股,沿臂叢方向走行少許后轉(zhuǎn)向內(nèi)下進入胸腔。2.應(yīng)在膈神經(jīng)外側(cè)、與C6神經(jīng)根、上干、上干前股內(nèi)側(cè)的間隙中尋找副膈神經(jīng)。實驗二大鼠單側(cè)膈肌麻痹模型的建立與評價目的采用在頸部分別切斷膈神經(jīng)(PN)和副膈神經(jīng)(APN)的方法建立大鼠單側(cè)膈肌麻痹模型,并對模型進行評價。方法雌性SD大鼠24只,隨機分為3組。左側(cè)為實驗側(cè)。將膈肌分成5個部分：胸骨部(st)、前肋部(an)、中肋部(mid)、后肋部(po)和腰部(1u)。在實驗處理前先采集左右兩側(cè)膈肌共10個部位的EMG做基線對照。制作動物模型：A組：頸部切斷PN和APN；B組：僅切斷PN;C組：對照組。各組神經(jīng)處理完畢后30min再次記錄兩側(cè)膈肌EMG。術(shù)后4W,進行肺功能、膈肌大體觀察和電生理活動以及兩側(cè)不同部位膈肌、入肌前膈神經(jīng)的病理組織學(xué)檢測。結(jié)果1.術(shù)后30min：A組患側(cè)各部位膈肌完全麻痹,均無可見收縮,未引出EMG；健側(cè)膈肌EMG活動明顯增強。B組患側(cè)膈肌不全麻痹,EMG st、an消失,EMGpo、lu存在；健側(cè)膈肌活動也有增強。2.術(shù)后4W：A組潮氣量(TV)明顯小于B、C組(P0.05),其它參數(shù)與B、C組相比無顯著差異；而B、C組間肺功能所有參數(shù)均無顯著差異。A組患側(cè)膈肌仍完全麻痹；B組患側(cè)膈肌麻痹范圍縮小,可引出EMG的范圍增大。入肌前患側(cè)膈神經(jīng)有髓神經(jīng)纖維數(shù)目B、C組分別為78±13根、447±56根,有顯著差異(P0.05),而A組無有髓神經(jīng)纖維�；紓�(cè)各部位膈肌肌纖維平均截面積A組均小于C組(P0.05)；而B組僅胸骨部(st)小于C組(P0.05)(與A組無差異),其余部位與C組無差異。結(jié)論采用在頸部分別切斷膈神經(jīng)和副膈神經(jīng)的方法能夠制作可靠的大鼠單側(cè)膈肌麻痹模型。電生理活動以及兩側(cè)不同部位膈肌、入肌前膈神經(jīng)的病理組織學(xué)檢測。第二部分單側(cè)膈肌麻痹對大鼠肺功能的影響目的評價單側(cè)膈肌麻痹對大鼠靜息和運動后肺功能的影響,從肺功能的角度探討膈神經(jīng)移位或結(jié)合2根肋間神經(jīng)移位修復(fù)臂叢神經(jīng)損傷的安全性,以及修復(fù)膈神經(jīng)的必要性和有效性。方法雌性SD大鼠132只,隨機分為4組。左側(cè)為實驗側(cè)。A組在頸部將膈神經(jīng)(PN)和副膈神經(jīng)(APN)均切斷：B組在將PN和APN均切斷的同時用第3、4肋間神經(jīng)(ICN)運動支經(jīng)神經(jīng)移植修復(fù)頸部PN遠端；C組在切斷PN、APN的同時再切斷第3、4 ICN運動支；D組為對照組。術(shù)后1、2、4、8、12、24W進行靜息肺功能、中等強度有氧運動后肺功能和遞增運動試驗力竭時間的檢測。結(jié)果靜息狀態(tài)下A、B、C組的PIF顯著小于D組(P0.05)(A、B、C組間無差異),其他參數(shù)MV、F、TV、Ti、Te、PEF、EF50各組間均無顯著差異。運動前、后的肺功能動態(tài)變化顯示,術(shù)后1W,A組運動后即刻的F、MV明顯小于D組(P0.05),Ti明顯大于D組(P0.05)；運動停止后12～15min,A組的MV與D組無明顯差異(P0.05)；而F和Ti仍與D組有顯著差異(P0.05),A組F大于D組,Ti小于D組。術(shù)后2、4、8、12、24W,各組間各參數(shù)均無顯著差異。術(shù)后各時間點的力竭時間均無組間差異(P0.05)。結(jié)論1.單側(cè)膈肌麻痹對靜息肺功能有一定程度的持續(xù)性損害(主要為PIF降低),但不影響通氣量和呼吸模式。2.單側(cè)膈肌麻痹后早期,中等強度有氧運動中存在通氣量減低和運動后恢復(fù)期延長,之后能逐漸恢復(fù)。對高強度運動能力無明顯影響。3.膈神經(jīng)伴2根肋間神經(jīng)損傷不會進一步影響肺功能,兩者同時移位修復(fù)臂叢神經(jīng)損傷是安全的。4.肋間神經(jīng)修復(fù)膈神經(jīng)后靜息和運動后的肺功能與單側(cè)膈肌麻痹后不修復(fù)膈神經(jīng)相比無明顯差異。第三部分單側(cè)膈肌麻痹對大鼠膈肌功能的影響目的評價單側(cè)膈肌麻痹對大鼠膈肌功能的影響,從膈肌功能的角度探討肋間神經(jīng)修復(fù)膈神經(jīng)的有效性和必要性。方法SPF級雌性SD大鼠132只,隨機分為4組。左側(cè)為實驗側(cè)。A組在頸部將膈神經(jīng)(PN)和副膈神經(jīng)(APN)均切斷；B組在將PN和APN均切斷的同時用第3、4肋間神經(jīng)(ICN)運動支經(jīng)神經(jīng)移植修復(fù)頸部PN遠端；C組在切斷PN、APN的同時再切斷第3、4ICN運動支；D組為對照組。術(shù)后1、2、4、8、12、24W分別進行生理、電生理和病理組織學(xué)檢測。結(jié)果1.平靜呼吸時食道內(nèi)壓(Peso)和膈肌EMG。術(shù)后各時間點各組間Peso無顯著差異。健側(cè)EMG:A、B、C組的EMG活動在術(shù)后1、2W時均大于D組(P0.05),之后與D組無明顯差異。患側(cè)EMG：A、C組未引出；B組在術(shù)后4W也未引出,在術(shù)后8、12、24W可引出逐漸增強的EMG,術(shù)后8、12W時小于D組(P0.05),術(shù)后24W時與D組無顯著差異。2.大鼠噴嚏時的Peso和健側(cè)膈肌EMG。術(shù)后各時間點各組間均無顯著差異。3.健側(cè)膈肌EMG頻譜分析。高/低頻比值(H/L)術(shù)后各時間點各組間無顯著差異(P0.05)。中心頻率(Fc)在術(shù)后1、2W時無組間差異；術(shù)后4、8W A、B、C組D組(P0.05)：術(shù)后12WA、B、C組B、D組(P0.05)；術(shù)后24WA、C組B、D組(P0.05)。4.膈肌CMAP。健側(cè)：術(shù)后各時間點各組的Amp和Lat均無顯著差異(P0.05)。患側(cè)：A、C組術(shù)后未引出；B組在術(shù)后4W也未引出,在術(shù)后8、12、24W可引出與D組相比Amp低、Lat長的CMAP(P0.05)。5.膈肌肌纖維平均截面積。患側(cè)：術(shù)后1、2W各組間無差異；術(shù)后4W,A、B、C組D組(P0.05)；術(shù)后8、12、24W,A、C組B、D組(P0.05)。健側(cè)：術(shù)后1、2、4、8、12W各組間均無顯著差異；術(shù)后24W,A、C組B、D組(P0.05)。6.肺泡隔面密度。術(shù)后各時間點各組間均無顯著差異。7.患側(cè)入肌前膈神經(jīng)有髓神經(jīng)纖維數(shù)目。A、C組無有髓神經(jīng)纖維；術(shù)后4、8、12、24W,B組有髓神經(jīng)纖維數(shù)目均少于D組(P0.05)。結(jié)論1.單側(cè)膈肌麻痹后仍然可以產(chǎn)生平靜呼吸時的正常胸腔內(nèi)壓力。健側(cè)膈肌無疲勞。2.膈神經(jīng)和2根肋間神經(jīng)同時移位修復(fù)臂叢神經(jīng)損傷不會引起呼吸系統(tǒng)的失代償。3.與單側(cè)膈肌麻痹后不修復(fù)膈神經(jīng)相比,肋間神經(jīng)修復(fù)膈神經(jīng)無明顯功能上的優(yōu)勢。
[Abstract]:The first part of the rat phrenic paralysis model was established to observe the anatomical observation of the accessory phrenic nerve in rats. The anatomical position of the accessory phrenic nerve (APN) in the neck of the rat was observed and the location of the APN was found. Methods 28 female SD rats were treated with bilateral phrenic nerve (PN) and the accessory phrenic nerve (APN) in the neck. The occurrence rate of APN was recorded and the location of the rat was recorded. The diameter of PN and APN and the distance between PN and APN at the level of C7 nerve root were measured respectively. Results the occurrence rate of APN was 91.1%, of which the left side was 92.8%, the right 89.3%. originated from the C6 nerve root, the upper trunk, the anterior femoral root, and the upper trunk 9.8%, 23.53%, 49.02%, and all APN of the 17.65%. were issued by the brachial plexus. In the same direction of the brachial plexus, they walked independently to the lower or lower direction of the PN, and entered the upper thoracic cavity on the outside of the PN. In the process of downlink, APN walked in front of C7, middle and outer 1/3 accounted for 54.9%, 23.53%, 21.57%.APN diameter 0.14 + 0.01mm (0.09-0.18mm), about PN diameter (0.32 + 0.02mm) (0.21 ~ 0.43mm) 44%. across C 7 the average distance between APN and PN was 0.36 + 0.06mm (0 ~ 1.64mm) in front of the nerve root. Conclusion the incidence of parphial nerve in the 1. rats is higher than that of the phrenic nerve. It can originate from the C6 nerve root, up the trunk, the femoral root and the upper trunk before the upper trunk, and go along the brachial plexus to the thoracic cavity and enter the thoracic cavity to the outside of the phrenic nerve, with the C6 nerve root and up to the upper trunk. The establishment and evaluation of unilateral diaphragm paralysis model in two rats was established and evaluated by cutting the phrenic nerve (PN) and accessory phrenic nerve (APN) in the neck to establish the rat unilateral diaphragm paralysis model, and the model was evaluated. Methods 24 female SD rats were randomly divided into 3 groups. The left side was real. The diaphragmatic muscles were divided into 5 parts: the sternum (st), the anterior rib (an), the middle rib (MID), the posterior rib (PO) and the waist (1U). Before the experimental treatment, the EMG was taken as the baseline control. The animal model was made: the A group: the neck severed PN and APN; the B group: only the PN; the C group: the control group was finished. After 30min, the lung function, the general observation of the diaphragm and the electrophysiological activities and the phrenic muscle in different parts of the two sides and the phrenic nerve were detected by histopathology. Results after 1., the diaphragmatic muscles of each part of the side of the 30min:A group were completely paralyzed, without visible contraction, without EMG, and the EMG activity of the contralateral diaphragmatic muscle was obviously enhanced. B group suffered from incomplete paralysis of the phrenic muscle, EMG st, an disappeared, EMGpo, Lu existed, and the activity of the contralateral diaphragm muscle activity also enhanced the tidal volume of 4W:A group (TV) after.2. operation (TV) was significantly smaller than B, C group (P0.05), but there was no significant difference in all parameters of lung function between the groups. The scope of arthralgia narrowed, the range of EMG was increased. The number of myelinated nerve fibers in the phrenic nerve before entering the muscle was B, and the group C was 78 + 13 and 447 + 56 respectively. There was a significant difference (P0.05), while the A group had no myelinated nerve fibers. The average cross-sectional area of the phrenic muscle fiber in the affected side of the affected side was smaller than that of the C group (P0.05); and the only sternal part (st) was smaller than the C group (P0.05) (P0.05) in the B group. There was no difference between the other parts of the group) and the other parts were not different from that in the C group. Conclusion using the method of severing the phrenic and accessory phrenic nerve in the neck can make a reliable model of unilateral diaphragm paralysis in rats. Electrophysiologic activity and the diaphragmatic muscles of different parts of the two sides and the pathological examination of the phrenic nerve before entering the muscle. The second part of unilateral diaphragm paralysis has the function of pulmonary function in rats. Objective to evaluate the effect of unilateral diaphragmatic paralysis on the resting and postoperative pulmonary function in rats. The safety of phrenic nerve transfer or 2 intercostal nerve transposition for repair of brachial plexus injury, and the necessity and effectiveness of repairing the phrenic nerve were investigated from the point of view of the lung function. Methods 132 female SD rats were randomly divided into 4 groups. In the lateral.A group, the phrenic nerve (PN) and the accessory phrenic nerve (APN) were cut off in the neck. Group B was used to repair the distal end of the neck with the motor branch of the intercostal nerve (ICN), while PN and APN were cut off, while the C group was cut off PN, and the APN was at the same time. Results the PIF of A, B, C in group C was significantly less than that of group D (P0.05) (A, B, C group), and there were no significant differences between the other parameters of A, B, C group. Obviously less than group D (P0.05), Ti was significantly greater than group D (P0.05), and there was no significant difference between MV and D group in group A after 12 to 15min (P0.05), while F and Ti still had significant differences. 0.05) 0.05. Conclusion 1. unilateral diaphragmatic paralysis has a certain degree of sustained damage to resting lung function (mainly reduced), but it does not affect the volume of ventilation and the early stage of respiratory mode.2. unilateral diaphragm paralysis. There is a decrease of ventilation in the middle intensity aerobic exercise and the prolonged recovery period after exercise, and it can be gradually recovered after the exercise. The ability to exercise high intensity is not clear. The effect of.3. phrenic nerve with 2 intercostal nerve injuries does not further affect the pulmonary function. Both the two simultaneous displacement repair of the brachial plexus injury is a safe.4. intercostal nerve repair of the phrenic nerve after the phrenic nerve repair and the pulmonary function after the unilateral diaphragm paralysis does not repair the phrenic nerve after the unilateral diaphragm paralysis. The third part of unilateral diaphragm paralysis in rats Objective to evaluate the effect of diaphragmatic function on the function of diaphragmatic muscle in rats and to explore the effectiveness and necessity of intercostal nerve repair from the angle of diaphragm function. Methods 132 female SD rats of grade SPF were randomly divided into 4 groups. The left side of the experimental group was in the neck group, and the phrenic nerve (PN) and the accessory phrenic nerve (APN) were cut off in the neck and B group. At the same time when PN and APN were cut off, the 3,4 intercostal nerve (ICN) motor branch was used to repair the distal PN of the neck, and the C group severed the 3,4ICN motor branch at the same time of cutting off PN and APN, and the D group was the control group. The physiological, electrophysiologic and histopathological tests were carried out in 1,2,4,8,12,24W after the operation. Results 1. the internal pressure of the esophagus (Peso) and the internal pressure of the esophagus (Peso) were in the same period of calm respiration. There was no significant difference in Peso between each time point after EMG. of the diaphragm. The EMG activity in the healthy side of the healthy side was larger than that of the group D (P0.05) in the group of EMG:A, B, and C, and there was no significant difference between the D group and the D group. There was no significant difference between the.2. rats and the D group. There was no significant difference in the EMG spectrum analysis of the.3. healthy phrenic muscle at each time point in each time point of the Peso and the healthy side of the diaphragm. There was no significant difference between the high / low frequency ratio (H/L) at all time points after the operation (P0.05). The central frequency (Fc) had no difference between groups at the postoperative 1,2W. 12WA, B, C group B, D group (P0.05), 24WA, C group B, D group (P0.05).4. diaphragmatic muscle after operation. Section area. Affected side: there was no difference between 1,2W groups after operation, after operation 4W, A, B, group C D (P0.05), 8,12,24W, A, C B, D group and healthy side after operation without significant difference; after operation, there was no significant difference between each group after the operation. The number of medullary nerve fibers was.A, no myelinated nerve fibers were found in group C. The number of myelinated nerve fibers in group 4,8,12,24W and B was less than that in group D (P0.05). Conclusion 1. unilateral diaphragmatic paralysis still can produce normal intrapleural pressure in calm respiration. No fatigue.2. phrenic nerve and 2 intercostal nerves are displaced to repair brachial plexus nerve injury in the healthy side of the contralateral diaphragm. Respiratory system decompensation. 3. Compared with unilateral diaphragmatic paralysis without repairing the phrenic nerve, intercostal nerve has no obvious functional advantage in repairing the phrenic nerve.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R565.3
本文編號：2173326
[Abstract]:The first part of the rat phrenic paralysis model was established to observe the anatomical observation of the accessory phrenic nerve in rats. The anatomical position of the accessory phrenic nerve (APN) in the neck of the rat was observed and the location of the APN was found. Methods 28 female SD rats were treated with bilateral phrenic nerve (PN) and the accessory phrenic nerve (APN) in the neck. The occurrence rate of APN was recorded and the location of the rat was recorded. The diameter of PN and APN and the distance between PN and APN at the level of C7 nerve root were measured respectively. Results the occurrence rate of APN was 91.1%, of which the left side was 92.8%, the right 89.3%. originated from the C6 nerve root, the upper trunk, the anterior femoral root, and the upper trunk 9.8%, 23.53%, 49.02%, and all APN of the 17.65%. were issued by the brachial plexus. In the same direction of the brachial plexus, they walked independently to the lower or lower direction of the PN, and entered the upper thoracic cavity on the outside of the PN. In the process of downlink, APN walked in front of C7, middle and outer 1/3 accounted for 54.9%, 23.53%, 21.57%.APN diameter 0.14 + 0.01mm (0.09-0.18mm), about PN diameter (0.32 + 0.02mm) (0.21 ~ 0.43mm) 44%. across C 7 the average distance between APN and PN was 0.36 + 0.06mm (0 ~ 1.64mm) in front of the nerve root. Conclusion the incidence of parphial nerve in the 1. rats is higher than that of the phrenic nerve. It can originate from the C6 nerve root, up the trunk, the femoral root and the upper trunk before the upper trunk, and go along the brachial plexus to the thoracic cavity and enter the thoracic cavity to the outside of the phrenic nerve, with the C6 nerve root and up to the upper trunk. The establishment and evaluation of unilateral diaphragm paralysis model in two rats was established and evaluated by cutting the phrenic nerve (PN) and accessory phrenic nerve (APN) in the neck to establish the rat unilateral diaphragm paralysis model, and the model was evaluated. Methods 24 female SD rats were randomly divided into 3 groups. The left side was real. The diaphragmatic muscles were divided into 5 parts: the sternum (st), the anterior rib (an), the middle rib (MID), the posterior rib (PO) and the waist (1U). Before the experimental treatment, the EMG was taken as the baseline control. The animal model was made: the A group: the neck severed PN and APN; the B group: only the PN; the C group: the control group was finished. After 30min, the lung function, the general observation of the diaphragm and the electrophysiological activities and the phrenic muscle in different parts of the two sides and the phrenic nerve were detected by histopathology. Results after 1., the diaphragmatic muscles of each part of the side of the 30min:A group were completely paralyzed, without visible contraction, without EMG, and the EMG activity of the contralateral diaphragmatic muscle was obviously enhanced. B group suffered from incomplete paralysis of the phrenic muscle, EMG st, an disappeared, EMGpo, Lu existed, and the activity of the contralateral diaphragm muscle activity also enhanced the tidal volume of 4W:A group (TV) after.2. operation (TV) was significantly smaller than B, C group (P0.05), but there was no significant difference in all parameters of lung function between the groups. The scope of arthralgia narrowed, the range of EMG was increased. The number of myelinated nerve fibers in the phrenic nerve before entering the muscle was B, and the group C was 78 + 13 and 447 + 56 respectively. There was a significant difference (P0.05), while the A group had no myelinated nerve fibers. The average cross-sectional area of the phrenic muscle fiber in the affected side of the affected side was smaller than that of the C group (P0.05); and the only sternal part (st) was smaller than the C group (P0.05) (P0.05) in the B group. There was no difference between the other parts of the group) and the other parts were not different from that in the C group. Conclusion using the method of severing the phrenic and accessory phrenic nerve in the neck can make a reliable model of unilateral diaphragm paralysis in rats. Electrophysiologic activity and the diaphragmatic muscles of different parts of the two sides and the pathological examination of the phrenic nerve before entering the muscle. The second part of unilateral diaphragm paralysis has the function of pulmonary function in rats. Objective to evaluate the effect of unilateral diaphragmatic paralysis on the resting and postoperative pulmonary function in rats. The safety of phrenic nerve transfer or 2 intercostal nerve transposition for repair of brachial plexus injury, and the necessity and effectiveness of repairing the phrenic nerve were investigated from the point of view of the lung function. Methods 132 female SD rats were randomly divided into 4 groups. In the lateral.A group, the phrenic nerve (PN) and the accessory phrenic nerve (APN) were cut off in the neck. Group B was used to repair the distal end of the neck with the motor branch of the intercostal nerve (ICN), while PN and APN were cut off, while the C group was cut off PN, and the APN was at the same time. Results the PIF of A, B, C in group C was significantly less than that of group D (P0.05) (A, B, C group), and there were no significant differences between the other parameters of A, B, C group. Obviously less than group D (P0.05), Ti was significantly greater than group D (P0.05), and there was no significant difference between MV and D group in group A after 12 to 15min (P0.05), while F and Ti still had significant differences. 0.05) 0.05. Conclusion 1. unilateral diaphragmatic paralysis has a certain degree of sustained damage to resting lung function (mainly reduced), but it does not affect the volume of ventilation and the early stage of respiratory mode.2. unilateral diaphragm paralysis. There is a decrease of ventilation in the middle intensity aerobic exercise and the prolonged recovery period after exercise, and it can be gradually recovered after the exercise. The ability to exercise high intensity is not clear. The effect of.3. phrenic nerve with 2 intercostal nerve injuries does not further affect the pulmonary function. Both the two simultaneous displacement repair of the brachial plexus injury is a safe.4. intercostal nerve repair of the phrenic nerve after the phrenic nerve repair and the pulmonary function after the unilateral diaphragm paralysis does not repair the phrenic nerve after the unilateral diaphragm paralysis. The third part of unilateral diaphragm paralysis in rats Objective to evaluate the effect of diaphragmatic function on the function of diaphragmatic muscle in rats and to explore the effectiveness and necessity of intercostal nerve repair from the angle of diaphragm function. Methods 132 female SD rats of grade SPF were randomly divided into 4 groups. The left side of the experimental group was in the neck group, and the phrenic nerve (PN) and the accessory phrenic nerve (APN) were cut off in the neck and B group. At the same time when PN and APN were cut off, the 3,4 intercostal nerve (ICN) motor branch was used to repair the distal PN of the neck, and the C group severed the 3,4ICN motor branch at the same time of cutting off PN and APN, and the D group was the control group. The physiological, electrophysiologic and histopathological tests were carried out in 1,2,4,8,12,24W after the operation. Results 1. the internal pressure of the esophagus (Peso) and the internal pressure of the esophagus (Peso) were in the same period of calm respiration. There was no significant difference in Peso between each time point after EMG. of the diaphragm. The EMG activity in the healthy side of the healthy side was larger than that of the group D (P0.05) in the group of EMG:A, B, and C, and there was no significant difference between the D group and the D group. There was no significant difference between the.2. rats and the D group. There was no significant difference in the EMG spectrum analysis of the.3. healthy phrenic muscle at each time point in each time point of the Peso and the healthy side of the diaphragm. There was no significant difference between the high / low frequency ratio (H/L) at all time points after the operation (P0.05). The central frequency (Fc) had no difference between groups at the postoperative 1,2W. 12WA, B, C group B, D group (P0.05), 24WA, C group B, D group (P0.05).4. diaphragmatic muscle after operation. Section area. Affected side: there was no difference between 1,2W groups after operation, after operation 4W, A, B, group C D (P0.05), 8,12,24W, A, C B, D group and healthy side after operation without significant difference; after operation, there was no significant difference between each group after the operation. The number of medullary nerve fibers was.A, no myelinated nerve fibers were found in group C. The number of myelinated nerve fibers in group 4,8,12,24W and B was less than that in group D (P0.05). Conclusion 1. unilateral diaphragmatic paralysis still can produce normal intrapleural pressure in calm respiration. No fatigue.2. phrenic nerve and 2 intercostal nerves are displaced to repair brachial plexus nerve injury in the healthy side of the contralateral diaphragm. Respiratory system decompensation. 3. Compared with unilateral diaphragmatic paralysis without repairing the phrenic nerve, intercostal nerve has no obvious functional advantage in repairing the phrenic nerve.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R565.3
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