【作者】 张锦程；

【导师】 傅敏；

【作者基本信息】 苏州大学 ， 急诊医学， 2011， 硕士

【摘要】 目的:探索乙醇治疗急性脊髓型减压病的治疗效果及作用机制。方法:将58只新西兰大白兔复制成急性脊髓型减压病模型,随机分为乙醇治疗组(A组)25只,生理盐水对照组(B组)20只和空白对照组(C组)13只。放入动物舱内在15 min内用压缩空气加压至0.6MPa,停留60min,然后5±1min匀速减压至常压出舱。A组制成急性脊髓型减压病模型15只,B组8只,C组8只。A组出舱后用25%乙醇溶液3ml/kg,由耳缘静脉缓慢注射入血管;B组注射3 ml/kg生理盐水;C组不做任何处理。所有兔均在造模前和出舱3d后采用Tarlov法评估后肢运动、MRI及测量脊髓诱发电位(SCEP);所有兔于实验前、出舱后及出舱后1h行血涂片检查;最后处死,解剖观察并取胸腰髓做HE光镜检。结果:1、Tarlov评分:A组4.31±0.63;B组1.25±0.50(与A组比较,P<0.01)C组的1.20±0.83(与A组比较P<0.01)。2、MRI检查:A组胸腰脊髓仅见轻度肿胀。B组和C组:胸腰段脊髓肿胀,正常形态消失,并可见散在局灶性和弥漫性T2W高信号影。3、SCEP检测:A组的脊髓诱发电位N21潜伏期和波幅无明显变化。B组和C组的脊髓诱发电位N21潜伏期较进舱前明显延长(P<0.01),波幅明显降低(P<0.01)。4、大体观察:A组脊髓可见水肿,未见明显血管内气泡。B组和C组可见脊髓大量出血和血管内气泡。5、光镜观察:A组光镜下HE染色仅见脊髓内少量散在出血及炎症细胞浸润。B组和C组解剖可见尿潴留、肠胀气,光镜下可见脊髓弥漫出血、淤血,大量空泡及炎症细胞浸润。6、血涂片:出舱后1h:A组可见大量分散的血小板和红细胞。B组和C组可见血小板的大量聚集伴红细胞聚集。结论:乙醇在血管内外均有强大的消泡作用,可以有效地治疗血栓性气泡导致的机能和运动障碍。乙醇还可以显著扩张血管、改善血流动力学、改善血管痉挛和疏通微循环。综合以上作用乙醇疗法是治疗急性脊髓型减压病的一种快速有效的方法。更多还原

【Abstract】 Objective: To investigate the effect of alcohol therapy for acute spinal cord decompression sickness in rabbits.Methods: 58 healthy New Zealand rabbits were randomly divided into three groups :alcohol therapy group (A group) 25 rabbits, saline solution control group (B group) 20 rabbits and untreated control group (C group) 13 rabbits. Then put into the animal capsule, whose pressure was risen to 0.6 MPa by compressed air within 15 min,and maintained for 60 min. Then the capsule’s pressure was evenly decompressed to normal pressure within 5±1min. Observe the symptoms and signs, 31 experimental rabbits were successfully reproduced into model of acute spinal cord decompression sickness, alcohol therapy group (A group) 15 rabbits ,saline solution control group (B group) 8 rabbits and untreated control group (C group) 8 rabbits. The model rabbits in A group were injected 25% alcoholic solution (3ml/kg) through ear vein after decompression, whereas in the B group, 3ml/kg normal saline were instead of and without any therapy in C group. The N21of spinal cord evoked potential(SCEP)、magnetic resonance imaging(MRI) and Tarlov behavior score were used to assess motor neurologic function before compression and after 3 days decompression respectively. Spiral cord tissue was taken from each group and paraffin wax sections were dyed by HE. They were observed through microscope.Results: (1) Tarlov behavior score: A group 4.31±0.63;B group 1.25±0.50(compared with A group,p<0.01);C group 1.20±0.83(compared with A group p<0.01)。(2)MRI: A group: The thoracolumbar cord appeared mild swelling. B and C group: Thethoracolumbar appeared mild swelling. And the focal and diffuse hyperintenstiy were seen on spinal cord on T2W images.In addition, the morphplogy of spinal cord was disappeared below the level of thoracolumbar cord. (3) SCEP:A group: the latency and amplitude of N21 have no obviously changed after 3 days decompression. B and C group : the latency of N21 was longer after 3 days decompression than before compression(P<0.01),and the amplitude of N21 was decreased(P<0.01). (4)Macropathology: A group: We can observe the hydrops in myeloid tissue. There are no air bubbles in spinovascular. B and C group: Massive hemorrhage and air bubbles were observed in spinovascular. (5) Microscopic examination: A group: We can observe the inflammatory infiltration as chief manifest. B and C group : Retention of urine and intestinal tympanites were observed by macropathology.Through microscope we can observe local haemorrhage, extensive congestion,inflammatory cell infiltration in spinal cord. (6) Blood smear: A group: There were some dispersive platelets and red blood cells in blood smears. B and C group: We can observe some platelets aggregation and erythrocyte aggregation in blood smears.Conclusion: Alcohol have powerful effect of defoaming in and out of blood vessel. Alcohol also can expand blood vessel, improve hemodynamics, eliminate thrombus and air bubble, ameliorate blood vessel spasm and deoppilation microcirculation. then cured acute spinal cord decompression sickness. So alcohol therapy is a quick and effect method for acute spinal cord decompression sickness.更多还原