局灶性脑缺血再灌注损伤及物理治疗时间窗研究

在急性脑缺血再灌注损伤的机制及治疗研究方面，治疗因子介入治疗的时间窗问题始终备受广大研究者关注，它为临床治疗时机的选择提供依据。是继治疗因子本身的作用外，具有重要意义的研究方向。因治疗因子各自的作用机理不同、治疗对象本身具有个体差异、治疗的介入时间、维持剂量等实施方案及对结果的检测方法不同。治疗时间窗亦呈现出很大的差异。为此，以下将从脑缺血再灌注的时间窗概念、脑缺血损伤的发生、再灌注损伤及物理治疗因子显效方面阐述较理想的治疗时间窗。     

超短波对大鼠脑缺血再灌注损伤的治疗作用

目的 探讨超短波疗法对大鼠局灶性脑缺血再灌注的脑保护作用及机制.方法 应用Wistar大鼠制作大脑中动脉栓塞再灌注(MCAO)模型,梗死大脑中动脉2 h后再灌注18 h,采用Zea-Longa评分法进行评分,在再灌注18 h后用超短波治疗(超短波组),对照组不给予任何治疗.现测脑细胞含水量、2,3,5-三苯基四氮唑溶液染色脑梗死体积和细胞中bcl-2表达.结果 超短波疗法与对照组比较,对于局灶性脑缺血再灌注损伤有减少脑水肿,减少脑梗死体积和提高细胞bcl-2表达,且两组间比较差异有显著性.结论 适时的起短波治疗有减少脑水肿,减小脑梗死体积和抑制神经元细胞凋亡,可能减轻脑缺血再灌注损伤的作用,为脑血管病物理治疗提供新的治疗方式. )模型,梗死大脑中动脉2 h后再灌注18 h,采用Zea-Longa评分法进行评分,在再灌注18 h后用超短波治疗(超短波组),对照组不给予任何治疗.现测脑细胞含水量、2,3,5-三苯基四氮唑溶液染色脑梗死体积和细胞中bcl-2表达.结果 超短波疗法与对照组比较,对于局灶性脑缺血再灌注损伤有减少脑水肿,减少脑梗死体积和提高细胞bcl-2表达,且两组问比较差异有显著性.结论 适时的起短波 疗有减少脑水肿,减小脑梗死体积和抑制神经元细胞凋亡,可能减轻脑缺血再灌注损伤的作用,为脑血管病物理治疗提     

超短波和旋磁对局灶性脑缺血再灌注损伤的影响

目的 探讨超短波、旋磁治疗对大鼠局灶性脑缺血再灌注损伤的影响。方法 应用线栓法制作大鼠局灶性脑缺血再灌注模型。将52只健康Wistar大鼠随机分为假手术组、对照组、超短波治疗组（超短波组）及旋磁治疗组（旋磁组）。脑缺血再灌注后18h给予治疗，24h取脑，观察各组大鼠脑组织含水量、脑梗死体积及Bcl-2、Bax蛋白表达，进行组间比较。结果 脑缺血再灌注后18h，超短波治疗能减少脑含水量，减小梗死体积；超短波组与旋磁组Bcl-2的表达均提高，Bax蛋白表达降低，Bcl-2／Bax提高，超短波组与旋磁组间差异无统计学意义（P〉0．05）；在减少脑含水量和减小脑梗死体积方面，旋磁组与对照组比较，差异无统计学意义（P〉0．05）。结论 脑缺血再灌注后18h，应用超短波治疗对局灶性脑缺血再灌注损伤有显著疗效；本实验条件下旋磁治疗对改善脑水肿、减小脑梗死体积未见显著疗效，在改善凋亡方面有显著疗效。     

小剂量超短波对脑缺血再灌注损伤的保护作用的机制研究

目的通过观测小剂量超短波（USW）对大鼠脑缺血再灌注后脑梗死体积，脑组织中B细胞淋巴细胞瘤-xl（Bcl-xl）及肿瘤坏死因子-α（TNF-α）表达的影响，进一步探讨小剂量USW对脑缺血再灌注损伤保护作用的机制。方法用线栓法制备一侧大脑中动脉栓塞再灌注大鼠模型，造成大鼠右脑缺血2h再灌注24h，采用Longa5级评分法评定神经功能缺损程度。大鼠按体重随机分成空白对照组、对照组及超短波治疗组（USW组），后2组选择Longa5级评分法为2分的大鼠。所选大鼠均于再灌注24h后断头取脑，分别测定脑梗死灶体积、脑组织中Bcl-xl及TNF-α的表达。结果与对照组比较，USW组梗死体积及梗死体积占全脑体积的百分比均降低，差异具有统计学意义（P〈0．05）。与对照组比较，USW组脑组织中Bcl-xl表达增加，TNF-α水平降低，差异均具有统计学意义（P〈0．05）。结论小剂量超短波可通过增加Bcl-xl表达，降低TNF-α水平而抑制脑神经细胞凋亡，挽救半暗带，缩小脑梗死灶，减小梗死体积，从而保护脑缺血再灌注后损伤神经，进而提高治疗效果。     

超短波电场对金属周围升温变化的影响

Objective To study the temperature changes around metal in ultrashort wave electric-field and it's influence factors.Methods Medical ultrashort wave therapeutic instrument was used and output switen was set at the 1 st grade.After tuning, one end of metal object was placed into 0.2ml water contained in a plastic tube ( with a length of 2cm and diameter of 2mm).Temperature changes of water around metal in different conditions were measured by digital thermometer.In experiments, several different conditions were studied, such as the length of metal, the vertical distance between metal and electrodes, the location of metal ultrashort electric field and the action duration of ultrashort wave.Results Under the same condition, when the prolate axis of metal paralleled to electrodes and the real lengths of metal outside of electric field were 10cm, 20cm, 30cm, 50cm, 70cm, 90cm, water temperatures around metal rose 4.37, 8.30,18.00, 20.64, 32.92 and 38.96℃, respectively; when the prolate axis of metal paralleled to electrodes and the verticaldistances between metal and one electrode were 1.5, 3.0, 4.5 and 6.Ocm, water temperatures around metal rose 66.03,49.37, 14.80 and 0.87℃, respectively; when the prolate axis of metal was vertical to electrodes and the distanees between one end of metal and electrodes were 5, 9 and 15cm, water temperature around metal rose 56.10,26.64 and11.07℃, respectively; when the vertical distances between metal and the electrode edge were 0,5,10,15cm, water temperatures around metal rose 25.32 , 10.26 ,2.88 and 1.53℃, respectively;when the lengths of metal with a fixed-length,the included real length in electric field, were 20, 10 and 0cm, water temperatures around metal rose 2.84 , 4.04 and7.30℃ , respectively.Under the same condition, the action duration of ultrashort wave were changed to be 5 and 10min,water temperatures around metal rose 24.90 and 39.07℃, respectively.Conclusion This study show that the water temperature rising around metal will be relatively small when:( 1 ) the real length of metal is short ; ( 2 ) the prolate axis of metal parallels to electrodes and is placed in the middle area between two electrodes;(3)the distance between two electrodes increase and the action duration is short;(4)the overall length of metal is contained in electric field between electrodes,or the metal is kept away from electrodes edges.     

超短波电场对金属周围升温变化的影响

目的 探讨超短波电场对金属周围升温变化的影响因素.方法 采用医用超短波治疗仪1档,调谐,输出80 mA,取0.2 ml水作为载体,金属物一端深入水中,改变金属物长度、金属物与电极板间垂直距离、金属物在电磁场中的摆放位置以及超短波的作用时间,采用数字电偶温度表测量不同治疗条件前、后水温的变化.结果 相同条件下,金属线长轴平行于电极板,金属物场外实际长度为10 cm、20 cm、30 cm、50 cm、70 cm、90 cm时,其周围升温分别为4.37℃、8.30℃、18.00℃、20.64℃、32.92℃、38.96℃;金属物长轴平行于电极板,金属线与一侧电极板间垂直间距分别为1.5 cm、3.0 cm、4.5 cm、6.0 cm时,金属周围升温分别为66.03℃、49.37℃、14.80℃、0.87℃;如果金属物长轴垂直于电极板,金属一端与极板间距离为5 cm、9 cm、15 cm时,金属周围升温分别为56.10℃、26.64℃、11.07℃;金属与电场边缘的垂直间距为0 cm、5 cm、10 cm、15 cm时,金属周围升温分别为25.32℃、10.26℃、2.88℃、1.53℃;固定长度的金属物,涵盖入电场内的实际长度分别为20 cm、10 cm、0 cm时,金属周围升温分别为2.84℃、4.04℃、7.30℃;同等条件下,改变超短波作用时间为5 min、10 min时,金属周围升温分别为24.90℃、39.07℃.结论 当金属物长轴平行置于电极板正中间位置,且金属完全置于电场内并远离极板边缘时,通过减短金属物的长度、两极板间的距离以及超短波的作用时间,可降低金属物周围的升温幅度.

Abstract：

Objective To study the temperature changes around metal in ultrashort wave electric-field and it's influence factors.Methods Medical ultrashort wave therapeutic instrument was used and output switen was set at the 1 st grade.After tuning, one end of metal object was placed into 0.2ml water contained in a plastic tube ( with a length of 2cm and diameter of 2mm).Temperature changes of water around metal in different conditions were measured by digital thermometer.In experiments, several different conditions were studied, such as the length of metal, the vertical distance between metal and electrodes, the location of metal ultrashort electric field and the action duration of ultrashort wave.Results Under the same condition, when the prolate axis of metal paralleled to electrodes and the real lengths of metal outside of electric field were 10cm, 20cm, 30cm, 50cm, 70cm, 90cm, water temperatures around metal rose 4.37, 8.30,18.00, 20.64, 32.92 and 38.96℃, respectively; when the prolate axis of metal paralleled to electrodes and the verticaldistances between metal and one electrode were 1.5, 3.0, 4.5 and 6.Ocm, water temperatures around metal rose 66.03,49.37, 14.80 and 0.87℃, respectively; when the prolate axis of metal was vertical to electrodes and the distanees between one end of metal and electrodes were 5, 9 and 15cm, water temperature around metal rose 56.10,26.64 and11.07℃, respectively; when the vertical distances between metal and the electrode edge were 0,5,10,15cm, water temperatures around metal rose 25.32 , 10.26 ,2.88 and 1.53℃, respectively;when the lengths of metal with a fixed-length,the included real length in electric field, were 20, 10 and 0cm, water temperatures around metal rose 2.84 , 4.04 and7.30℃ , respectively.Under the same condition, the action duration of ultrashort wave were changed to be 5 and 10min,water temperatures around metal rose 24.90 and 39.07℃, respectively.Conclusion This study show that the water temperature rising around metal will be relatively small when:( 1 ) the real length of metal is short ; ( 2 ) the prolate axis of metal parallels to electrodes and is placed in the middle area between two electrodes;(3)the distance between two electrodes increase and the action duration is short;(4)the overall length of metal is contained in electric field between electrodes,or the metal is kept away from electrodes edges.     

脑缺血再灌注损伤后超短波治疗最佳时机的选择

目的:观察超高频电场-超短波对大鼠局灶性脑缺血再灌注损伤后脑水肿的影响以及最佳治疗时机。方法:实验于2004-06/10在中国医科大学附属第一医院理疗科实验室完成。①所用wistar大鼠共45只,随机分为6组:空白对照组(n=6)、对照组(n=8)和4个治疗组(n=31,立即治疗组、6h治疗组、12h治疗组和18h治疗组)。用线栓法制备各组大鼠一侧大脑中动脉栓塞-再灌注模型,造成大鼠右脑缺血2h再灌注24h。②治疗组分别于再灌注后立即、6h、12h、18h给予超短波治疗10min(频率为40.68MHz,最大输出功率为40W)。③空白对照组在造模中插线深度为1.0cm,不造成脑梗死;对照组于造模后给予超短波治疗处理过程但无输出。④采用Zea-Longa5级评分法评定神经功能缺损来筛选病例,剔除死亡及神经学评分为3,4级的大鼠,用干湿称重法测量符合实验标准的大鼠脑含水量,用苏木精-伊红染色光镜下观察形态学变化,比较各组大鼠脑含水量及病理学变化。结果:剔除死亡及神经学评分为3级和4级的大鼠9只,纳入结果分析的大鼠数量为36只,每组6只。①病理学观察结果:对照组病灶侧大脑半球体积明显增大,镜下可见神经元周围间隙明显增宽,核仁减小,浓缩甚至消失,血管腔内中性粒细胞增多明显。立即治疗组病理变化无减轻,而6,12,18h治疗组病灶侧可见中度或轻度水肿,血管腔内中性粒细胞增多轻微,病理损伤减轻。②脑含水量比较:对照组患侧脑含水量平均为(81.50±0.74)%,立即治疗组患侧脑含水量为(81.02±0.83)%,两组比较差异无显著性(q=1.53,P>0.05);6,12,18h治疗组患侧脑含水量分别为(79.78±0.70)%,(79.74±0.84)%和(79.39±1.06)%,均低于对照组,差异有显著性(q=5.49,5.61,6.73;P<0.05)。结论:超短波对大鼠局灶性脑缺血再灌注损伤具有神经保护作用,能减轻缺血侧脑含水量及病理改变,提示治疗最佳时机可能在再灌注6h后。     

1Hz重复经颅磁刺激对缺血性脑卒中后上肢运动功能的疗效

目的观察1 Hz重复经颅磁刺激(r TMS)对缺血性脑卒中后偏瘫上肢运动功能康复的效果。方法 40例缺血性脑卒中后上肢偏瘫患者被随机分配到治疗组(n=20)和对照组(n=20)。两组均给予常规康复治疗,治疗组采用r TMS刺激健侧皮层M1区,对照组给予假刺激。治疗后采用运动诱发电位(MEPs)、Fugl-Meyer上肢运动功能评分(FMA)和握力进行评定。结果治疗后,治疗组患侧MEPs振幅显著升高(P0.001)。治疗组握力和FMA评分显著优于对照组(P0.001),并至少可持续到治疗结束后1个月。所有患者均能耐受10次治疗,无严重不良反应发生。结论 r TMS刺激健侧皮层M1区可改善缺血性脑卒中后偏瘫上肢的运动功能。     

脑缺血再灌注损伤后超短波治疗最佳时机的选择

目的：观察超高频电场-超短波对大鼠局灶性脑缺血再灌注损伤后脑水肿的影响以及最佳治疗时机。方法：实验于2004-06／10在中国医科大学附属第一医院理疗科实验室完成。①所用wistar大鼠共45只，随机分为6组：空白对照组（n=6）、对照组m=8）和4个治疗组（n=31，立即治疗组、6h治疗组、12h治疗组和18h治疗组）。用线栓法制备各组大鼠一侧大脑中动脉栓塞-再灌注模型，造成大鼠右脑缺血2h再灌注24h。②治疗组分别于再灌注后立即、6h、12h、18h给予超短波治疗10min（频率为40．68MHz，最大输出功率为40W）。③空白对照组在造模中插线深度为1．0cm，不造成脑梗死；对照组于造模后给予超短波治疗处理过程但无输出。④采用Zea-Longa 5级评分法评定神经功能缺损来筛选病例，剔除死亡及神经学评分为3，4级的大鼠，用干湿称重法测量符合实验标准的大鼠脑含水量，用苏木精-伊红染色光镜下观察形态学变化，比较各组大鼠脑含水量及病理学变化。结果：剔除死亡及神经学评分为3级和4级的大鼠9只，纳入结果分析的大鼠数量为36只，每组6只。①病理学观察结果：对照组病灶侧大脑半球体积明显增大，镜下可见神经元周围间隙明显增宽，核仁减小，浓缩甚至消失，血管腔内中性粒细胞增多明显。立即治疗组病理变化无减轻，而6，12，18h治疗组病灶侧可见中度或轻度水肿，血管腔内中性粒细胞增多轻微，病理损伤减轻。②脑含水量比较：对照组患侧脑含水量平均为（81．50&;#177;0．74）％，立即治疗组患侧脑含水量为（81．02&;#177;0．83）％，两组比较差异无显著性（q=1．53，P〉0．05）；6，12，18h治疗组患侧脑含水量分别为（79．78&;#177;0．70）％，（79．74&;#177;0．84）％和（79．39&;#177;1．06）％，均低于对照组，差异有显著性（q=5．49，5．61，6．73；P〈0．05）。结论：超短波对大鼠局灶性脑缺血再灌注损伤具有神经保护作用，能减轻缺血侧脑含水量及病理改变，提示治疗最佳时机可能在再灌注6h后。     

超短波电场对金属周围升温变化的影响

Objective To study the temperature changes around metal in ultrashort wave electric-field and it's influence factors.Methods Medical ultrashort wave therapeutic instrument was used and output switen was set at the 1 st grade.After tuning, one end of metal object was placed into 0.2ml water contained in a plastic tube ( with a length of 2cm and diameter of 2mm).Temperature changes of water around metal in different conditions were measured by digital thermometer.In experiments, several different conditions were studied, such as the length of metal, the vertical distance between metal and electrodes, the location of metal ultrashort electric field and the action duration of ultrashort wave.Results Under the same condition, when the prolate axis of metal paralleled to electrodes and the real lengths of metal outside of electric field were 10cm, 20cm, 30cm, 50cm, 70cm, 90cm, water temperatures around metal rose 4.37, 8.30,18.00, 20.64, 32.92 and 38.96℃, respectively; when the prolate axis of metal paralleled to electrodes and the verticaldistances between metal and one electrode were 1.5, 3.0, 4.5 and 6.Ocm, water temperatures around metal rose 66.03,49.37, 14.80 and 0.87℃, respectively; when the prolate axis of metal was vertical to electrodes and the distanees between one end of metal and electrodes were 5, 9 and 15cm, water temperature around metal rose 56.10,26.64 and11.07℃, respectively; when the vertical distances between metal and the electrode edge were 0,5,10,15cm, water temperatures around metal rose 25.32 , 10.26 ,2.88 and 1.53℃, respectively;when the lengths of metal with a fixed-length,the included real length in electric field, were 20, 10 and 0cm, water temperatures around metal rose 2.84 , 4.04 and7.30℃ , respectively.Under the same condition, the action duration of ultrashort wave were changed to be 5 and 10min,water temperatures around metal rose 24.90 and 39.07℃, respectively.Conclusion This study show that the water temperature rising around metal will be relatively small when:( 1 ) the real length of metal is short ; ( 2 ) the prolate axis of metal parallels to electrodes and is placed in the middle area between two electrodes;(3)the distance between two electrodes increase and the action duration is short;(4)the overall length of metal is contained in electric field between electrodes,or the metal is kept away from electrodes edges.