本文選題：脊髓半切損傷　切入點(diǎn)：膈神經(jīng)　出處：《中國脊柱脊髓雜志》2017年02期

【摘要】：目的:應(yīng)用兔C3脊髓半切損傷模型造成單側(cè)膈肌癱瘓,觀測(cè)植入式膈神經(jīng)刺激器對(duì)膈肌功能恢復(fù)的有效性和組織相容性。方法:30只新西蘭大白兔隨機(jī)分為對(duì)照組(A組)和實(shí)驗(yàn)組(B組),每組15只,建立兔C3脊髓半切損傷模型造成單側(cè)膈肌癱瘓,并植入膈神經(jīng)刺激器。B組組每日施加電刺激干預(yù)(每日1次,每次8h),A組不施加電刺激干預(yù)。兩組分別于頸髓損傷前、術(shù)后1、2、4周行血?dú)夥治鰴z測(cè);術(shù)后1、2、4周對(duì)膈肌、膈神經(jīng)進(jìn)行形態(tài)學(xué)觀察,并對(duì)膈肌肌纖維細(xì)胞橫截面的面積進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:頸髓損傷術(shù)后1周,兩組PaO_2值都下降,PaCO_2都升高,但組間比較無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后2周A組PaO_2值開始回升,PaCO_2值無明顯變化,B組PaO_2值繼續(xù)降低,PaCO_2值繼續(xù)增大,兩組間比較存在統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)后4周B組PaO_2值明顯升高(未恢復(fù)至正常水平),PaCO_2恢復(fù)至正常水平,與A組相比存在統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后1周兩組膈肌細(xì)胞橫截面積無顯著差異(P0.05),術(shù)后2周、4周A組膈肌細(xì)胞橫截面積均較B組組明顯減小,與B組存在統(tǒng)計(jì)學(xué)差異(P0.05)。A組2周時(shí)膈肌細(xì)胞肌束膜及肌內(nèi)膜邊界不清,4周時(shí)局部肌細(xì)胞破壞;B組4周時(shí)肌細(xì)胞肌束膜及肌內(nèi)膜邊界仍清晰。A組術(shù)后1周時(shí)膈神經(jīng)結(jié)構(gòu)正常,2周時(shí)可見髓鞘增生,鞘索比例增大,數(shù)目減少;4周時(shí)可見髓鞘異常增生明顯,神經(jīng)間質(zhì)水腫,微管微絲線粒體大量缺失。B組膈神經(jīng)始終為正常結(jié)構(gòu)。結(jié)論:植入式膈神經(jīng)刺激器能夠促進(jìn)頸髓損傷后新西蘭大白兔膈肌呼吸功能的恢復(fù),其機(jī)制可能與膈神經(jīng)刺激能夠延緩頸髓損傷后膈肌萎縮和膈神經(jīng)變性有關(guān)。
[Abstract]:Aim: to observe the effectiveness and histocompatibility of implanted phrenic nerve stimulator on the recovery of diaphragm function in unilateral diaphragmatic paralysis caused by C3 spinal cord hemisection injury in rabbits.Methods Thirty New Zealand white rabbits were randomly divided into control group A (n = 15) and experimental group B (n = 15).Group B was implanted with phrenic nerve stimulator. Group B received electrical stimulation once a day.Before cervical spinal cord injury and 4 weeks after operation, blood gas analysis was performed in the two groups, the diaphragm and phrenic nerve were observed and the cross-sectional area of diaphragm fibroblasts was analyzed statistically.There was statistical difference between the two groups (P 0.05), and the PaO_2 value in group B was significantly higher than that in group A at 4 weeks after operation (no return to normal level) and there was a statistical difference between group A and group A (P 0.05).There was no significant difference in diaphragm cell cross-sectional area between the two groups at 1 week after operation (P 0.05), but at 2 weeks and 4 weeks after operation, the diaphragm cell cross-sectional area in group A was significantly smaller than that in group B.There is a statistical difference between group B and group P0.05. Group A: at 2 weeks after operation, the diaphragm myobiliary membrane and the boundary of the muscle endomembrane are unclear. In group B, the myocyte bundles and the boundary of the endomyocytes are still clear at 4 weeks after operation. The phrenic nerve in group A is still clear at 1 week after operation.Myelin proliferation could be seen at 2 weeks after normal structure.The proportion of sheath cord increased, the number of sheath decreased 4 weeks, the myelin sheath was abnormal hyperplasia, the nerve interstitial edema, microtubule microfilament mitochondria large number of missing. B group phrenic nerve is always normal structure.Conclusion: implanted phrenic nerve stimulator can promote the recovery of diaphragm respiratory function after cervical spinal cord injury in New Zealand white rabbits. The mechanism of phrenic nerve stimulation may be related to the delay of diaphragm atrophy and phrenic nerve degeneration after cervical spinal cord injury.
【作者單位】： 中國康復(fù)研究中心北京博愛醫(yī)院脊柱脊髓外科;首都醫(yī)科大學(xué)康復(fù)醫(yī)學(xué)院;
【基金】：首都衛(wèi)生發(fā)展科研專項(xiàng)課題(編號(hào):2011-6001-01)
【分類號(hào)】：R651.2;R-332

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