脊髓损伤后神经源性膀胱患者护理中集束化康复护理的应用分析

目的 研究脊髓损伤后神经源性膀胱患者护理中集束化康复护理的应用。方法 选取于2016年2月~2017年5月入院68例脊髓损伤后神经源性膀胱患者作为研究对象,按照随机数字表法分为对照组和研究组,每组39例。对照组选用常规方式予以护理,研究组基于常规方式选用集束化康复护理模式;比较两组脊髓损伤后神经源性膀胱患者护理后满意度与护理前后膀胱容量、残余尿量。结果 研究组护理后满意度为97.44%,高于对照组79.49%,差异有统计学意义（P＜0.05）。研究组护理前后膀胱容量分别为（199.64±20.05）ml、（408.87±23.14）ml,护理前后残余尿量分别为（185.29±19.86）ml、（69.71±11.75）ml,对照组护理前后膀胱容量分别为（199.73±20.12）ml、（300.41±19.88）ml,护理前后残余尿量分别为（184.93±19.94）ml、（107.64±15.28）ml,两组患者护理后膀胱容量、残余尿量优于护理前,差异有统计学意义（P＜0.05）;研究组护理后膀胱容量、残余尿量优于对照组,差异有统计学意义（P＜0.05）。结论 脊髓损伤后神经源性膀胱患者护理中集束化康复护理的应用效果显著,可供临床参考。     

脑源性神经营养因子与脊髓损伤

<正> Spinal cord injury(SCI)is such a serious disease that itwould bring heavy burdens of both health and economy tothe victims as well as the society.Although worldwide med-ical researchers of neuroscience have made great efforts toattempt to solve this big problem for nearly a century, there     

重复经颅磁刺激结合间歇导尿对脊髓损伤后神经源性膀胱患儿的尿动力学及排尿功能的影响

目的:分析重复经颅磁刺激(repeated transcranial magnetic stimulation,rTMS)结合间歇导尿对脊髓损伤后神经源性膀胱患儿的尿动力学及排尿功能的影响.方法:将2019年1月至2021年郑州大学附属儿童医院收治的60例脊髓损伤后神经源性膀胱患儿作为研究对象,根据入院先后顺序编号,采...     

不同脊髓损伤模型大鼠行为学及形态学的变化

背景：在脊髓全断模型中有切割伤模型、切除伤模型,为了更好地选择脊髓损伤修复研究的全断动物模型,有必要对这两种模型进行比较及探讨。 目的：分析不同脊髓损伤模型的行为学及病理变化,选择适用于再生研究及治疗的脊髓损伤动物模型。 方法：将160只SD大鼠随机均分为2组,分别制作切割型脊髓损伤模型与切除型脊髓损伤模型,术后1,2,4,8,10,20,30,50周内进行后肢行为学BBB评分及组织化学、免疫组织化学染色,观察损伤区残余纤维情况;术后4,10,26,52周分别在大鼠脑皮质运动区与颈髓注射BDA-FITC示踪剂,观察损伤区残余纤维的连续性。 结果与结论：切割脊髓损伤模型组大鼠术后2-50周双后肢的BBB得分明显高于切除脊髓损伤模型组(P < 0.05);切割脊髓损伤模型组在损伤区残存大量组织和神经丝、胶质纤维酸性蛋白纤维,而切除脊髓损伤模型几乎没有残存纤维;不论是切割脊髓损伤模型还是切除脊髓损伤模型,皮质脊髓束均不能通过损伤区,终止于损伤区的头端;在切割脊髓损伤模型中,脊髓固有束重新进入尾侧端的宿主脊髓组织中,而在切除脊髓损伤模型中脊髓固有束终止于损伤区的头端。表明切除脊髓损伤模型更适用于脊髓损伤后再生效果及治疗手段或药物的筛选与评价。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程      

体外诱导的皮肤源性神经干细胞在大鼠受损伤脊髓内的存活和分化

为寻找新的神经干细胞来源用于治疗急性脊髓损伤的实验研究,本实验采用绿色荧光大鼠（GFP转基因鼠）有毛皮肤在体外经剪碎,胰酶消化,过滤细胞,无血清培养液培养分离细胞,用表皮生长因子和成纤维细胞生长因子促进细胞增殖,去除生长因子后用含血清培养液培养细胞等过程,采用神经上皮干细胞蛋白（nestin）、微管相关蛋白（MAP2）、神经丝蛋白（NF-200）和胶质原纤维酸性蛋白（GFAP）抗体免疫细胞化学染色法对培养细胞的分化状况进行鉴定。结果：培养3d的细胞大多数出现贴壁或死亡,仅少量悬浮生长,5～6d时悬浮生长细胞增殖成球形,10d已形成较多的细胞球。     

坐骨神经损伤大鼠模型鞘内移植神经干细胞后脊髓背角和背根神经节脑源性神经营养因子的表达

背景：坐骨神经损伤模型可测试伤害性的热刺激和机械刺激所引发的痛觉过敏及冷、触觉异常。 目的：观察坐骨神经损伤模型大鼠鞘内移植神经干细胞后脊髓背角和背根神经节脑源性神经营养因子的表达。 方法：72只SD大鼠随机均分为假手术组、对照组和实验组。对照组和实验组制作坐骨神经损伤模型,假手术组仅暴露坐骨神经,不结扎。分别于造模后第3,10天进行鞘内移植,实验组注入30 μL的神经干细胞悬液,空白组和对照组注入30 μL的细胞培养液。 结果与结论：与假手术组相比,对照组和实验组移植后3 d机械痛阈和热痛阈逐渐降低,至移植后7 d降低至最低点(P < 0.01),于移植后21 d恢复至移植前水平;实验组移植后7,14 d机械痛阈和热痛阈较对照组明显上升(P < 0.01)。与对照组相比,假手术组移植后7,14,21 d各组大鼠脑源性神经营养因子的表达呈低水平(P < 0.05);移植后14,21 d,实验组脑源性神经营养因子的表达量高于对照组(P < 0.05)。提示鞘内移植神经干细胞可提高脊髓背角和背根神经节中脑源性神经营养因子的表达。从而抑制了周围神经损伤产生的神经病理性疼痛。 关键词：脑源性神经营养因子;神经干细胞;慢性限制损伤;脊髓背角;背根神经节 doi:10.3969/j.issn.1673-8225.2012.10.031     

低频电刺激对脊髓损伤后膀胱过度活动抑制的仿真研究

目的 探讨低频脉冲（0～10Hz）刺激时,不同刺激波形对脊髓损伤后逼尿肌反射亢进诱发的膀胱过度活动症的结果,以寻求抑制膀胱过度活动的最优刺激波形.方法 首先根据McNeal的神经纤维电缆模型,基于Frankenhaeuser-Huxley （FH） 方程建立有髓神经纤维的膜外点电极刺激的仿真系统,评价低频电刺激中的四种波形,即正向脉冲、负向脉冲、双向对称脉冲、双向不对称脉冲的效果.通过电刺激脊髓损伤犬的阴部神经实验,验证仿真条件下最优刺激波形的临床效果.结果 仿真实验表明双向不对称脉冲的抑制效果最佳;动物实验表明以3V、0.1ms的正向脉冲为起始脉冲,结合1V、0.3ms的负向脉冲的双向不对称波形的抑制效果为最优.结论 低频脉冲刺激脊髓损伤犬阴部神经时,正向脉冲在前的双向不对称脉冲的刺激波形仿真效果最佳,并适用于临床实验,能够有效抑制膀胱过度活动,保护神经避免电化学损伤.     

脊髓压迫性损伤大鼠海马和脊髓内BDNF的表达变化

目的探讨脑源性神经营养因子(BDNF)在脊髓压迫性损伤后的表达变化及作用。方法用自行设计的方法制作脊髓压迫模型,免疫荧光检测BDNF在星形胶质细胞、神经元和上下行轴突的表达;WB检测BDNF在大鼠海马及脊髓的表达。结果随着时间延长,受损部位的BDNF+-GFAP荧光强度逐渐增强;BDNF+-Tuj1荧光强度逐渐减弱;受损部位相邻上下段的BDNF+-NF200比受损部位的明显增强。海马和脊髓受损中心相邻的上、下段的BDNF蛋白表达在损伤后1d达到峰值,然后逐渐下降(P0.05);而脊髓受损中心的BDNF蛋白表达逐渐下降(P0.05)。结论脊髓损伤后,BDNF的表达下调,随伤后时间呈一定规律变化,是引起受损部位神经元表达下降的原因之一。     

电刺激联合神经营养素3可促进脊髓损伤大鼠内源性神经干细胞的增殖和分化

文题释义： 神经营养素3：是神经生长因子基因家族的成员,可促进多种中枢和外周神经元的存活和分化,调节神经元突触活动,并对神经系统发育和成熟起重要作用。神经营养素3在损伤条件下对神经元具有保护作用,因而在治疗神经系统疾病和神经损伤中有临床应用前景。 内源性神经干细胞：正常机体中,神经干细胞一般处于静息状态,在特定的生理或病理刺激下被激活,其中侧脑室外侧壁的室下带和海马齿状回的颗粒下带是产生神经干细胞最为活跃的区域,神经系统损伤后,在多种细胞因子、调控基因的调节下发生增殖、迁移和分化等。 背景：由于外源性神经干细胞的获取有限,且容易产生免疫排斥以及伦理问题等严重制约其向临床转化,因此如何激活内源性神经干细胞并促进其生长增殖、分化,成为近期科研工作者究的热点。 目的：探讨电刺激联合神经营养素3对大鼠脊髓损伤后内源性神经干细胞增殖及向神经元分化的作用。 方法：将96只SD大鼠随机分为假手术组、脊髓损伤组、电刺激组、电刺激+神经营养素3组,每组24只。假手术组仅暴露脊髓,其他3组大鼠应用改良Allen法建立脊髓损伤模型,造模后给予相应措施进行干预。造模后7,14,21,28 d时,以BBB评分评价大鼠后肢运动功能,电生理学检查运动诱发电位潜伏期;造模后28 d取材,进行苏木精-伊红染色观察脊髓病理变化,免疫组化染色观察内源性神经干细胞的增殖和分化情况。实验方案经兰州大学第二医院医学伦理委员会批准。 结果与结论：①与假手术组相比,脊髓损伤组大鼠的BBB评分明显降低(P < 0.01),脊髓组织可见大量炎症细胞浸润,并存在多个空洞;与脊髓损伤组相比,电刺激组、电刺激+神经营养素3组大鼠后肢功能开始逐渐恢复,电刺激+神经营养素3组BBB评分明显高于电刺激组(P < 0.05),上述病理损伤变化明显改善;②脊髓损伤组7,14 d及电刺激组大鼠7 d时双后肢运动诱发电位潜伏期均未测出,电刺激组、电刺激+神经营养素3组21,28 d时运动诱发电位潜伏期较模型组缩短(P < 0.05),电刺激+神经营养素3组潜伏期缩短更显著    (P < 0.05);③BrdU和Nestin阳性细胞数、微管相关蛋白2的表达：电刺激+神经营养素3组>电刺激组>脊髓损伤组;胶质纤维酸性蛋白的表达：脊髓损伤组>电刺激组>电刺激+神经营养素3组。结果表明脊髓损伤大鼠经电刺激及神经营养素3干预后,促进内源性神经干细胞增殖和向神经元分化,病理损伤明显减轻,后肢运动功能显著改善。 ORCID: 0000-0002-6353-8874(张培根) 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

Electrical stimulation of the spinal cord in cardiovascular disease

The early and late outcomes of electrical stimulation of the spinal cord are analyzed in chronic critical ischemia of the lower extremities and coronary heart disease with peripheral involvement of coronary arteries. The clinical capacities of this treatment that has enjoyed little use in our country due to its high cost showed atraumaticity of electrical stimulation of the spinal cord; a few cases of complications and no hospital mortality; a rapid positive clinical effect after the initiation of electric neurostimulation, and better life quality in patients in the postoperative periods.     

Phrenic nerve stimulation in patients with spinal cord injury

Phrenic nerve pacing (PNP) is a clinically useful technique to restore inspiratory muscle function in patients with respiratory failure secondary to cervical spinal cord injury. In this review, patient evaluation, equipment, methods of implementation, clinical outcomes, and the complications and side effects of PNP are discussed. Despite considerable technical development, and clinical success, however, current PNP systems have significant limitations. Even in patients with intact phrenic nerve function, PNP is successful in achieving full-time support in ～50% of patients. Inadequate inspired volume generation may arise secondary to incomplete diaphragm activation, reversed recruitment order of motor units, fiber type conversion resulting in reduced force generating capacity and lack of coincident intercostal muscle activation. A novel method of pacing is under development which involves stimulating spinal cord tracts which synapse with the inspiratory motoneuron pools. This technique results in combined activation of the intercostal muscles and diaphragm in concert and holds promise to provide a more physiologic and effective method of PNP.     

Importance of anesthesia for the genesis of neurogenic pulmonary edema in spinal cord injury

There are reports describing both provocation and inhibition of neurogenic pulmonary edema by anesthetic drugs. Therefore, we compared the effect of two types of anesthesia on the formation of neurogenic pulmonary edema in rats with balloon-induced acute spinal cord injury. Animals with sham procedure (group 1) were anesthesized by intraperitoneal sodium pentobarbital. In the experimental groups, rats were submitted to acute spinal cord lesion by insufflations of a balloon in the epidural space at T8 for 1 min (group 3 under i.p. sodium pentobarbital and group 2 under i.p. xylazine-ketamine anesthesia). In rats with pentobarbital anesthesia, systolic blood pressure doubled the baseline value during compression, whereas this effect was less pronounced in the ketamine-xylazine group. The pulmonary index (100 x wet lung weight/body weight) was 0.395 (+/-0.018) in sham-operated rats, rose to 0.499 (+/-0.060) in group 2, and was maximum under pentobarbital anesthesia (0.639+/-0.14; p=0.0018). Histologic examination of the spinal cord showed parenchymal ruptures and acute hemorrhage. Comparison of the pulmonary index with histologic slides of lung parenchyma revealed that relevant intra-alveolar edema occurred only for index values above 0.55. On electron microscopy, endothelial alterations, and damage of the alveolar lining cells were found. Our study indicates that neurogenic pulmonary edema caused by spinal cord injury is less pronounced in rats under xylazine-ketamine anesthesia, when compared with pentobarbital.     

脊髓全横断大鼠模型的构建

背景：脊髓全横断模型在造模时常难以保证神经纤维的完全离断。 目的：构建大鼠脊髓全横断损伤模型。 方法：将大鼠随机分为模型组和假手术组。模型组构建脊髓T10节段全横断模型;假手术组动物仅打开椎管与硬脊膜而后缝合,但不损伤脊髓。建模后1,3,5,7 d分别进行BBB评分以评估后肢运动功能,检测其体感诱发电位和运动诱发电位来评估神经传导通路的完整性,并行形态学观察来评估脊髓肉眼观病理形态。 结果与结论：与假手术组相比,模型组大鼠在建模后1,3,5,7 d时,其BBB评分降低(P < 0.01),未检测出体感和运动诱发电位。形态学观察结果显示模型组大鼠脊髓完全横断,而假手术组脊髓形态完整。结果提示实验成功构建了大鼠脊髓全横断模型。     

Determining appropriate models for joint control using surface electrical stimulation of soleus in spinal cord injury

The mechanical impedance of the ankle joint during electrical stimulation of the soleus is studied by applying constant-velocity 10° angular perturbations to the ankle and measuring the resultant torque. Both neurologically intact subjects and spinal cord injured subjects are tested. Lumped, piecewise linear models are developed to predict the torque from the measured displacement and acceleration signals. The commonly used second-order mass-spring-dashpot model fails to predict the changes in torque that occur following imposed movements. A fiveelement, directionally-dependent piecewise linear model is much better at predicting the measured responses for velocities up to 50° s⁻¹. Numerical least squared error indentification techniques are used to estimate the model parameters for three neurologically intact and three spinal cord injured subjects. The average error between the model’s response and the measured response across all subjects is 10·9%. There is some evidence that a velocity-dependent non-linear model could produce better results than the directionally-dependent piecewise linear model.     

振荡电场刺激治疗脊髓损伤的研究进展

脊髓损伤是一种发病率较高的致残病变.振荡电场刺激可以促进损伤的轴突再生.就近年来振荡电场刺激治疗脊髓损伤的进展进行了综述,包括人体临床试验、联合疗法的应用、治疗领域的拓展以及作用机理上的进展,同时指出了目前研究中存在的问题,并对发展趋势进行了展望.     

miR-124 regulates neural stem cells in the treatment of spinal cord injury

Several studies demonstrated that the overexpression of miR-124 in neural stem cells (NSCs) could lead the NSCs to differentiate into neurons and astrocytes, which may be important for functional recovery in spinal cord injury. The present study attempted to explore the potential repairing effect of the NSCs transfected with miR-124 for the rats with spinal cord injury (SCI). NSCs transfected with miR-124 were transplanted into rats by intravenous injection after SCI. The effects of miR-124 on the differentiation of NSCs and the treatment for the SCI-model rats were experimentally investigated. The reduction of cavity volume in focal lesions and Basso–Beattie–Bresnahan (BBB) scores were used as the criteria of functional recovery of the SCI-model rats. Up-regulation of miR-124 promoted the differentiation of NSCs. Transfection of miR-124 in NSCs dramatically increased the percentage of NeuN-positive cells, and reduced the percentage of GFAP-positive cells in vitro and in vivo respectively. All of the rats treated with NSCs transfected with miR-124 achieved the better functional recovery than the ones in NSCs and sham control groups. Furthermore, the systemic delivery of the NSCs transfected with miR-124 resulted in a reduction of lesion cavity volume of SCI-model rats. Thus, Overexpression of miR-124 can promote the differentiation of NSCs and play an important role in the repair of SCI. The utility of intravenous delivery of stem cells regulated with miR-124 to target lesion areas as a prospective therapeutic approach in acute spinal cord injury is very promising in the future.     

临床相关的脊髓损伤动物模型新进展

自1911年首个脊髓损伤动物模型建立以来,相继出现切割损伤型、牵拉损伤型、压迫损伤型和缺血损伤型等模拟临床不同环境的脊髓损伤动物模型。迄今,这些模型在建立过程中不断融入许多新技术:计算机控制的精确打击、定位下的精准切割,数字化的牵拉器及符合生物力学的脊髓压迫器等。科学技术的发展促进了脊髓损伤动物模型更加贴近不同的临床状态。     

Early capsaicin intervention for neurogenic bladder in a rat model of spinal cord injury

We explored capsaicin pretreatment, prior to spinal trauma, as a method to prevent the development of neurogenic detrusor overactivity (NDO) and urethral-bladder dyssynergia reflex after spinal cord injury (SCI). In addition, the duration of effect of capsaicin therapy on NDO in a rat model of SCI was investigated. Two sets of experiments were performed on female Sprague Dawley rats transected at the T9-T10 spinal level. First, SCI rats received capsaicin (125 mg/kg s.q.) 3-4 days before and 4-5 days after SCI. Cystometrograms (CMG) was performed 4 weeks after injury. In the second set of experiments, serial CMG in the same SCI animal was performed after one time injection of capsaicin (125 mg/kg s.q.) 4 weeks after spinalization. There were no differences in intercontraction intervals, voiding efficiency, or voiding pressure between the capsaicin pretreated and control SCI rats. However, the number of uninhibited detrusor contractions decreased 4 weeks after injury. We found that a single dose of capsaicin suppressed uninhibited detrusor contractions for 34 days in the chronic SCI animals. Early therapy with capsaicin was able to prevent/reduce detrusor hyperreflexia in spinal cord injured animals 4 weeks after injury. Early vanilloid therapy may prevent development of urologic sequelae after SCI.