發(fā)布時間：2018-02-26 19:33

  本文關鍵詞： 急性脊髓損傷 加味防己黃芪湯 甲強龍 并發(fā)癥　出處：《福建中醫(yī)藥大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的：通過實驗及臨床研究加味防己黃芪湯與大劑量甲強龍聯合應用治療急性脊髓損傷,觀察其早期療效及安全性。方法：72只雌性SD大鼠隨機分為3組：MP組、聯合組(加味防己黃芪湯+MP)及空白組,每組各24只。三組術后Id,3d,7d,14d進行BBB評分評估大鼠脊髓運動功能恢復情況；術后1d、3d、7d取標本行TUNE L染色觀察損傷脊髓細胞凋亡情況；術后14d取標本行HE染色觀察脊髓病理學改變情況。2013年05月至2014年09月,將受傷時間在8小時內的45例急性脊髓損傷患者隨機分為MP組和聯合組。MP組22人,給予甲強龍沖擊治療；聯合組23人,在MP組的基礎上口服加味防己黃芪湯濃縮液6周。于治療前后根據ASIA標準評定脊髓神經功能情況,并觀察各組并發(fā)癥發(fā)生的情況。結果：大鼠BBB評分結果顯示,術后三組大鼠隨著時間推移脊髓神經功能評分均有所提高；術后3d、7d、14d聯合組及MP組的BBB評分提高明顯高于空白組(P0.05)；而聯合組于術后7d、14d評分優(yōu)于MP組(P0.05)。TUNEL染色結果顯示：三組大鼠脊髓均可見TUNEL陽性凋亡細胞,術后3d凋亡細胞數量達到最高峰,術后7d明顯減少；其中術后1d、3d、7d聯合組及MP組的凋亡細胞數均少于空白組(P0.05),并且聯合組于術后3d、7d少于MP組(P0.05)。HE染色結果顯示：三組脊髓正常結構均有所破壞,細胞結構不完整,膠質細胞增生,空腔形成；聯合組和MP組與空白組相比脊髓結構更完整,正常神經細胞保留更多,膠質細胞增生更少,形成的空腔更少；聯合組與MP組相比脊髓損傷范圍更小,組織結構更清晰,細胞結構更完整,偶見空腔,數量明顯減少,存活神經細胞數更多,膠質細胞增生不明顯�；颊咧委�6周后,MP組及聯合組患者的脊髓神經感覺及運動功能均有明顯恢復。聯合組患者的感覺、運動、ASIA分級改善及并發(fā)癥減少優(yōu)于MP組(P0.05)。結論：1.加味防己黃芪湯與大劑量甲強龍聯用能減少大鼠損傷脊髓的細胞凋亡,減輕脊髓損傷的病理改變,提高大鼠脊髓神經功能的恢復；2.加味防己黃芪湯與大劑量甲強龍聯用能提高臨床上患者脊髓功能恢復,同時能減少感染及電解質紊亂情況的發(fā)生。
[Abstract]:Objective: to observe the early curative effect and safety of modified Fangji Huangqi decoction combined with high dose methylenolone in the treatment of acute spinal cord injury. Methods: Seventy-two female Sprague-Dawley rats were randomly divided into 3 groups: group 1: MP. The rats in the combined group (modified Fangji Huangqi decoction) and the blank group (24 rats in each group) were evaluated with BBB score on the 3rd day after operation for 7 days and 14 days after operation, and the TUNE L staining was used to observe the apoptosis of injured spinal cord cells at 1 day, 3 days and 7 days after operation. From May 2013 to September 2014, 45 patients with acute spinal cord injury who had been injured within 8 hours were randomly divided into MP group (n = 22) and combined group (n = 22). 23 patients in the combined group were treated with modified Fangzhenhuangqi decoction for 6 weeks on the basis of MP. The neurological function of spinal cord was evaluated according to ASIA standard before and after treatment, and the complications in each group were observed. Results: the results of BBB score showed that there were no significant differences between the two groups. The neurological function scores of the spinal cord in the three groups improved with time after operation. The BBB score of the combined group and MP group was significantly higher than that of the blank group on the 3rd day after operation, and the score of the combined group was better than that of the MP group on the 7th day after operation. The results of Tunel staining showed that TUNEL positive apoptotic cells were found in the spinal cord of all the three groups, and the number of apoptotic cells reached the highest level on the 3rd day after operation. The number of apoptotic cells in the combined group and MP group was less than that in the blank group on the 1st and 3rd day after operation, and in the combined group was less than that in the MP group on the 3rd day after operation. The results of HE staining showed that the normal structure of spinal cord was damaged and the cell structure was incomplete in the three groups. The combined group and MP group had more intact spinal cord structure, more normal nerve cells, less glial cell proliferation and less cavity formation, and the combined group and MP group had smaller range of spinal cord injury than MP group. The tissue structure is clearer, the cell structure is more complete, the cavity is occasionally empty, the number is significantly reduced, and the number of surviving nerve cells is more. Glial cell proliferation was not obvious. After 6 weeks of treatment, the sensory and motor functions of spinal cord in MP group and combined group were significantly recovered. The improvement of Asia grade and the decrease of complications were better than that of MP group (P 0.05). Conclusion the combination of modified Fangji Huangqi decoction and high dose methylenolone can reduce the apoptosis of injured spinal cord cells and alleviate the pathological changes of spinal cord injury in rats. The combination of modified Fangji Huangqi decoction and high dose of methylenolone can improve the recovery of spinal cord function and reduce the incidence of infection and electrolyte disturbance. 2.
【學位授予單位】：福建中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.2

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