【作者】 李强；

【导师】 李晶；

【作者基本信息】 中南大学 ， 临床医学， 2013， 硕士

【摘要】 第1章局部使用纳米银凝胶制剂对大鼠脊神经及软组织和重要内脏的毒性研究目的：探讨脊柱后路手术中,伤口局部使用纳米银凝胶对邻近的脊神经组织、软组织及重要内脏器官有无毒性作用及影响。方法：取健康SD大鼠48只,体重约80-100g,随机平均分为A组(空白对照组)及B、C组(实验组),每组16只。三组大鼠均行腰部后正中入路L4-6部位手术,显露并切开L5椎板撕裂相对应的硬脊膜,A组大鼠不放置任何制剂,直接缝合伤口；B、C组大鼠分别放入5mg/kg、1mg/kg体重的纳米银凝胶后缝合伤口。术后72小时和术后1个月每组各处死大鼠8只获取标本,对标本进行组织中银含量测定和病理组织学检查。结果：(1)术后72小时,两个试验组(B、C组)的所有组织标本内的银含量均高于空白组(A组)。进行SNK-q检验,证实差异有统计学意义。计算两试验组大鼠所有组织标本银含量均值95%可信区间,得到区间内的最高值为3.86μg/g(2)术后1个月,两个试验组大鼠的各类组织器官内的银含量与空白组的银含量相差细微,做SNK-q检验,证实组间差异无统计意义。(3)三组大鼠72小时、1个月时间段所取的脊髓、伤口周围肌肉、肝、肾、心、肺组织学检查均无显著病理性改变。结论：一定剂量范围内的纳米银凝胶局部用于大鼠脊柱后路手术伤口是安全的,包括短期(急性期)、长期(慢性期)都是安全的。第2章局部使用纳米银凝胶对大鼠脊柱后路手术术后感染预防作用观察目的：初步分析纳米银凝胶在预防大鼠的脊柱后路手术术后感染中的效果方法：健康SD大鼠20只,体重80-100克,随机均分为A组(空白对照组)、B组(实验组)。均行后路L4-6手术,伤口内放入Lux操纵子(发光基团)标记的葡萄球菌细菌悬液0.1ml,并在伤口内放入一段金属异物(克氏针);A组伤口直接缝合,B组大鼠伤口内另放入1mg/kg体重剂量的纳米银凝胶后缝合。两组均于术后2周用IVIS100可见光成像系统行活体生物荧光照相并计算感染大鼠的数量,照相后处死动物,取标本做病理组织学检查。结果：(1)A组感染率为88.9%,B组感染率为40%,采用卡方检验,证实组间差异有统计学意义。(2)伤口周围肌肉组织病理切片检查结果：A组大部分呈明显炎性改变；B组未见异常。结论：局部应用纳米银凝胶预防大鼠脊柱后路手术术后感染是有效可行的。第3章局部使用纳米银凝胶制剂对大鼠脊柱后路手术术后感染的治疗作用目的：观察纳米银凝胶局部使用治疗大鼠脊柱后路手术术后感染的效果。方法：对30只SD大鼠全部进行腰椎后路手术(具体方法同第二章A组),在手术后1周时行荧光照相,确认感染的再次随机平均分为2组,A组仅行清创手术,保留克氏针；B组行清创、保留克氏针并放入1mg/kg纳米银凝胶。术后继续饲养动物至清创术后2周,麻醉动物行活体生物荧光照相确认感染数量,照相之后处死大鼠行病理学检查。结果：30只大鼠经第一次手术,1只麻醉意外死亡,剩下29只,经荧光照相,26只确认感染。最终结果如下：(1)A组：经清创手术后,死亡率：46.1%,感染控制率：38.5%。(2)B组：经清创手术手术后,死亡率：8.3%,感染控制率：83.3%。采用卡方检验,证实A、B组死亡率、感染率组间差异有统计学意义。(3)伤口肌肉组织病检结果：A组大部分明显炎症、水肿、坏死,B组大部分正常。结论：纳米银凝胶对大鼠脊柱后路手术术后感染的治疗作用是有效的。更多还原

【Abstract】 Part Ⅰ:Experimental Study on toxicity of local use of nano-silver gel to adjacent soft tissue, neural structure and vital organs in ratsObjective:To investigate whether local use of nano-silver gel causes toxicity on adjacent soft tissue, neural elements and remote vital internal organs.Methods:A total of48SD healthy rats, Weight about80-100g,which divided into Group A (blank control group), Group B、 C(experimental group), randomly,16rats in each group,Surgical approach selects posterior approach operation, exposure L4-6rat spinal posterior vertebral plate, open the dura mater of corresponding L5lamina, Group A conduct nothing into the wounds,group B and Group C conduct in5mg/lmg nano-silver per kg of body weight into the wounds, After72hours and a month, each time each group sacrifice eight rats and take specimens, then tests the silver content and take histological examination.Results:(1) Time slot of72hour, The silver content in all tissues of two experimental groups(Group B、C) are higher than the blank group, SNK-q test of the data, the results proved that there was statistical difference between various organizations of the Group. Calculate the95%confidence interval of two groups of rats’all tissues silver content, get the highest value is3.86μg/g (2) Time slot of1month,the two test groups (group B, C), The silver content of all kinds of tissues and organs of rats is slight difference from the blank group, SNK-q test of the data, the results proved that there was no statistical difference between various organizations of the group.(3)No obvious pathological changes were detected by the spinal cord, muscle, liver, kidney around the wound, heart, lung histology examination by the time slot of of72hours and1months-Conclusion:It is safe for the nanometer silver gel’s local use of rats’ spinal operation wound within a certain range, Includes short-term (acute period) and long-term (chronic period).Part Ⅱ Experimental Study on nano-silver gel for preventive effect of spinal infection after posterior spinal surgery in ratsObjective:Preliminary analysis the infection of the nano-silver gel in preventing spine infection of rats after posterior spinal surgerymethods:the new20SD rats, Weight about80-100g, which were divided into group A (control group), group B (experimental group), group C (experimental group) randomly. Operate all by the site L4-6,all experimental animal conduct into0.1ml of Staphylococcus aureus suspension labeled with the Lux-operon (luminescence gene),And conduct the metallic foreign body into the wound (Kirschner wire), while B group conduct the nanometer silver gel(1mg/kg), blank group with nothing. After2weeks, with the anesthesia, animal were take photography by IVIS100visible light imaging system (XENOGEN) on the wound, After take photography on the2weeks. sacrifice the animal, Specimens were taken for pathological examinationResults:(1) The infection rate of Group A is88.9%, and the infection rate of Group B is40%. use the chi-square test, The results confirmed that the statistically significant difference in infection rates(2)Pathological examination results:most wound tissue of the rats in group A are Inflammatory changed, while most wound tissue of the rats in group B are not inflammatory changed.Conclusion:Local application of nano-silver gel is feasible and effective in prophylaxis and treatment of postoperative infection after posterior spinal surgeryPart Ⅲ Therapeutic effect by local application of nanometer silver gel on spinal infection after posterior spinal surgery in ratsObjective:Observe the effect of nanometer silver gel for the treatment of rat spinal infection after posterior spinal surgeryMethods:posterior spinal surgery were taked to30SD rats(The specific method are the same Group A),. Take Fluorography to confirm infection a week after operation., rats that were confirmed to be infected enter the next step experiment, then the rat was confirmed to be infection were randomly divided into2groups again. The blank control group,(group A) simple take debridement, Kirschner wire retained, The test group B conduct gel1mg/kg in the wound, and Kirschner wire retained also, After the operation,animal were feed to2weeks, then take fluorography to get the number of the rats that are infected, then sacrifice the animal and take the wound tissue to pathological examination.Results:a total of30rats,1died because of anesthesia accident,26were confirmed to be infected in the29rats remained, The last result:(1) Group A:The mortality after Debridement operation:46.1%, Infection control rate:38.5%.(2) Group B:The mortality after Debridement operation:8.3%, Infection control rate:83.3%. Use the chi-square test to test, The results confirmed that mortality and infection rate between Group A、 B were Statistical significance different.(3)Pathological results of2week:The wound of muscle tissue obvious inflammation, edema, necrosis, while Group B almost normal.Conclusion:It is effective for the nano-silver gel to the treat the spinal infection after rats posterior spinal surgery更多还原