摘要
目的 通过建立大鼠海水浸泡脊髓损伤动物模型,探讨海水浸泡对脊髓损伤的影响、早期甲基强的松龙的治疗作用以及便携式注射泵的应用可行性。方法 利用改良Allen’s打击法加海水浸泡建立大鼠海水浸泡脊髓损伤模型,在干预结束后不同时间段观察海水浸泡对大鼠神经功能、伤段脊髓病理变化、水电解质以及线粒体呼吸功能、线粒体ATP酶活力等指标的变化。并比较便携式注射泵与常用注射泵的一些特性。结果 尽管海水浸泡早期可能延迟脊髓组织的继发性水肿,但最终是加重了脊髓损伤的程度;海水浸泡增加伤段脊髓组织水电解质紊乱和内皮素的释放;海水浸泡脊髓损伤后线粒体呼吸功能和ATP酶活性明显下降,超微结构改变明显;早期使用大剂量甲基强的松龙治疗,可明显提高伤段脊髓线粒体的呼吸功能、ATP酶的活性,线粒体超微结构改变轻;便携式注射泵在流量设定范围、精密度、使用条件方面与常用注射泵相似,但在组成简单,有防水性,便于携带和固定。结论 大鼠海水浸泡脊髓损伤动物模型制作成功;尽管早期海水浸泡延迟了创伤性脊髓水肿的出现,但最终加重了脊髓损伤,早期使用大剂量甲基强的松龙治疗,对海水浸泡脊髓损伤有一定的保护作用。便携式药物注射泵是海战时抢救脊髓损伤伤员的有效工具之一。
Objectives To study the effect of seawater immersion(SWI) on spinal cord injury(SCI) and the treatment of meta dose methylprednisolone(MP) by a animal model of SCI with SWI in rats. Then to explore the application possibility of portable syringe driver for the wounded with SCI in seawar. Methods The model in adult Sprague-Dawley rats were built based on modified Allen's SCI method and seawater immersion. At 6h, 12h, and 24h after SCI, neurological functions, pathological and ultrastructural changes, the content of electrolytes and water, respiratory function, activities of ATPase, the contents of intramitochondria free calcium and the level of GSH of extracted mitochondria were observed. Some properties of portable syringe driver were compared with those of clinically common used syringe driver. Results Although SWI delays the onset and peak of traumatic spinal cord edema following SCI, but can eventually aggravate the traumatic edema. SWI deteriorates water and electrolytes imbalance, and mitochondrial respiratory function, activities of ATPase, and level of GSH. SWI increases the level of ET and the overload of intramitochondria free calcium. Early-stage MP treatment could improve mitochondrial respiratory function, activities of ATPase and level of GSH in SCI rats with SWI. It also could decrease the overload of intramitochondria free calcium, inhibit the damage of ultrastructure of mitochondria. Portable syringe driver has some other properties such as simple component, waterproof, small appearance and size, which convenient for carry and use in seawar. Conclusions SWI deteriorates the conditions of SCI. There is neuroprotective effect of early-stage meta dose MP treatment in SCI rats with SWI. Portable syringe driver is a effective first-aid instrument for the wounded of spinal cord injury in seawar.
引文
1. Mautes AE, Weinzierl MR, Donovan F, et al. Vascular events after spinal cord injury: contribution to secondary pathogenesis [J]. Physical Therepy, 2000, 80(7): 673-687
2. Tator CH. Experimental and clinical studies of the pathophysiology and management of acute spinal cord injury [J]. J Spinal Cord Med, 1996, 19(4): 206-214
3. Trump BE, Berezesky ZK. Calcium-mediated cell injury and cell death[J]. Faseb, 1995;9(3): 219-228
4. Pointillart V, Petitjean, ME, Wiart L, et al. Pharmacological therapy of spinal cord injury during the acute phase [J]. Spinal Cord, 2000, 38(2): 71-76
5. Yuan EC, Mobley WC. Therapeutic potential of neurotrophic factor for neurologiclal disorders [J]. Ann Neurol, 1996, 40(8): 346-354
6. Allen AR. Remarks on the histopathological changes in the spinalcord due to impact. An experimental study[J]. J Nerv Ment Dis, 1914, 41 (2): 141-148
7. Tarlov IM, Klinger H, Vitales. Spinal cord compression studies. Experimental techniques to produce acute and gradual compression[J]. Arch Neurol Psy Chiatry, 1953, 70(7): 813-819
8. Molt JI. Analysis and measurement of some sources of variability in experimental spinal cord trauma[J]. J Neurosurg, 1979, 50(8): 784-789
9. Rivlin AS, Tator CH. Effect of duration of spinal cord compression in a new acute model in the rat[J]. Surg Neurol, 1978, 10(1): 39-43
10. Xu J, Kim GM, Ahmed SH, et al. Glucocorticoid receptor-mediated suppression of activator protein-1 activation and matrix metalloproteinase expression after spinal cord injury[J]. J Neurosci, 2001, 21(1): 92-97
11.刘锐,刘宗惠,虞积跃,等.海水浸泡对创伤性脑水肿的实验研究[J].第二军医大学学报,2002,23(2):159-162
12.黄宏,王正国,赖西南,等.海水浸泡弹道伤骨骼肌组织的病理变化[J].第三军医大学学报,2001,23(6):753-755
13. Kimelberg HK, Mongin AA. Swelling-activated release of excitatory amino acids in the brain: relevance for pathophysiology[J]. Contrib Nephrol, 1998, 123(2): 240-257
14.陆松敏,刘建仓,万志红,等.海水浸泡失血性休克大鼠肝、心肌线粒体功能的改变[J].中国病理生理杂志,2001,17(11):1111
15.王大鹏,李辉,虞积耀,等.海水浸泡对胸部开放伤实验犬血浆钠、钾、氯离子浓度的影响[J].海军医学杂志.2003,24(3):207-210
16.李辉,鹿尔驯,虞积耀,等.胸部开放伤后海水浸泡致多器官功能障碍综合征[J].中华外科杂志,2000,38(8):630-632
17.李辉,鹿尔驯,虞积耀,等.胸部开放伤后海水浸泡对实验犬血浆渗透压及电解质平衡的影响[J].中国危重病急救医学,2000,12(6):356-358
18. Nasa S, Schimizu A, Kino K, et al. Development of experimental modelof an acute respiratory failure by intratracheal seawater infusion: a comparisonwith a conventional oleic acid induction. Res Exp Med Berl, 1994, 194(1): 25-33
19. Sawada S, Ichiba S, Itano H, et al. Experimental study of partial liquidventilation in the setting of acute respiratory failure induced by sea water lung lavage in rabbits[J]. Acta Med Okayama, 1998, 52(3): 131-137
20. Folkesson HG, Kheradmand F, Mattay MA.The effect of salt water onaiveolar epithelial barrier function [J]. Am J Respir Crit Care Med, 1994, 150(11): 1555-1563
21. Ghaanador GB, Stothert JC, Basadre, et al. Comparison of the pulmo2nary lymphatic and hemodynamic changes of near-drowning in a sheepmodel[J]. Circ Shock, 1992, 38 (4): 245-252