图形翻转视觉诱发电位在视神经管减压后视神经损伤不同时期的
变化特征*★
薛 飞,曹云莉,李泽卿,王秋萍,吴昆旻,季俊峰
Changes of visual evoked potentials in traumatic optic nerve injury model following optic nerve decompression
Abstract
AIM: To observe the changes of the visual evoked potentials and find out the correlation between operation opportunity and clinical effect of traumatic optic nerve injuries in the optic neuropathy models following the optic nerve decompression.
METHODS:The experiment was carried out in the Animal Experimental Center, Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA from March to May in 2005.①Thirty New Zealand rabbits were randomly divided into A, B, C, D and E groups, representing normal control, decompression in 2, 7, 14 days post-trauma, and non-decompression group respectively. Each group contained 6 rabbits.②Except the normal controls, other rabbits were chose for establishing the models of traumatic optic nerve injury by optic foramen occlusion with circular silica gel, in which diameter was 2 mm.③Before injury, 1 hours after injury, 1 hour before decompression, and 2 weeks after decompression, pattern reversal visual evoked potentials (P-VEP) was adopted to detect the optic functional change. The absolute latent period and amplitude of NPN contour P wave were recorded. Only a set of data in normal control group was selected.
RESULT: All of 30 rabbits were involved in the result analysis.①P-VEP of normal controlled rabbits revealed typical NPN contours, while NPN waves in injured rabbits were low and flat. The latent period of P wave was lengthened and the amplitude was reduced.②The latent period of P wave was shorter in B group post-decompression than that pre-decompression [(71.25±8.51), (86.47±14.28) ms, P < 0.05], and obviously longed in D group post-decompression than that pre-decompression [(158.73±15.16), (116.35±17.13) ms, P < 0.05]. Comparison on latent period of P wave in P-VEP before and after decompression showed the insignificant differences in C group (P > 0.05). The latent period of P wave was shorter in B and C groups compared with E group (P < 0.01), and obviously longer in C, D, E groups compared with A group (P < 0.01).③Comparison on the amplitude of P wave in P-VEP before and after decompression showed the significant differences in B group [(5.25±0.78), (4.42±0.42) μV, P < 0.05]. The amplitude of P wave post-decompression was lower in B group than in C and D groups (P < 0.01), also lower in D group than in C group (P < 0.05). Compared with A group, significant differences were found in C, D, E groups (P < 0.01).
CONCLUSION:The neural secondary injury is an important factor for visual impairment. The optic nerve decompression is beneficial to relieve the indirect optic nerve injuries. Visual function may be better improved by decompression within 48 hours after injury, which protect axonal secondary injury and deteriorate the damage of visual functions.
Xue F, Cao YL, Li ZQ, Wang QP, Wu KM, Ji JF.Changes of visual evoked potentials in traumatic optic nerve injury model following optic nerve decompression.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2007;11(22):4340-4343(China)
[www.zglckf.com/zglckf/ejournal/upfiles/07-22/22k-4340(ps).pdf
Department of Otorhinolaryngology- Head and Neck Surgery, Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA, Nanjing 210002, Jiangsu Province, China
Xue Fei★, Master, Attending physician, Department of Otorhinolaryngology- Head and Neck Surgery, Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA, Nanjing 210002, Jiangsu Province, China
fly.xue@263.net
Correspondence to: Wang Qiu-ping, Doctor, Chief physician, Department of Otorhinolaryngology- Head and Neck Surgery, Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA, Nanjing 210002, Jiangsu Province, China
Qpwang1016@vip.sina.com
Supported by: the Medical Scientific Research Key Program of Nanjing General Hospital, No. 2004060*
Received: 2006-05-25
Accepted: 2007-04-19
摘要
目的:观察视神经损伤动物模型在损伤后和不同时期视神经管减压后视觉诱发电位的变化,了解创伤性视神经损伤的手术时机与疗效的关系。
方法:实验于2005-03/05在解放军南京军区南京总医院动物实验中心完成。①实验分组:30只新西兰白兔随机分为正常对照组、术后2 d减压组、术后7 d减压组、术后14 d减压组、术后不减压组,每组6只。②造模:除正常对照组外,其余各组在视神经孔中塞入一细端为2 mm直径的圆锥软硅胶,阻塞视神经孔,造成视神经的挤压伤。③指标检测:采用图形翻转视觉诱发电位检测损伤前、损伤后1 h、减压前1 h、减压后2周视功能变化,记录NPN曲线主波(P波)的绝对潜伏期、绝对波幅。正常对照组仅采集一组数据作为对照。
结果:30只实验动物均进入结果分析。①正常对照组家兔图形翻转视觉诱发电位检查均引出典型NPN波型曲线,视神经挤压伤后1 h NPN波形低阔扁平,P波潜伏期延长,波幅降低。②P波潜伏期:术后2 d减压组减压后短于减压前 [(71.25±8.51),(86.47±14.28)ms,P < 0.05];术后7 d减压组减压前后比较差异无显著性 (P > 0.05);术后14 d减压组减压后明显长于减压前 [(158.73±15.16),(116.35±17.13)ms,P < 0.05]。术后2 d减压组和术后7 d减压组短于术后不减压组(P < 0.01)。术后7,14 d减压组和术后不减压组明显长于正常对照组(P < 0.01)。③P波波幅:术后2 d减压组减压后高于减压前 [(5.25±0.78),(4.42±0.42)μV,P < 0.05]。术后2 d减压组减压后低于术后7 d减压组、术后14 d减压组 (P < 0.01),术后14 d减压组低于术后7 d减压组(P < 0.05);术后7 d减压组、术后14 d减压组、术后不减压组低于正常对照组(P < 0.01)。
结论:神经元继发性损伤是视功能进行性下降的重要原因,视神经减压术有利于减轻视神经间接损伤,较早期(损伤后48 h以内)减压可阻止轴突继发性损伤,避免视功能进一步下降,并在一定程度上逆转视功能的损害。
关键词:视神经/损伤;诱发电位,视觉;动物模型
薛飞,曹云莉,李泽卿,王秋萍,吴昆旻,季俊峰.图形翻转视觉诱发电位在视神经管减压后视神经损伤不同时期的变化特征[J].中国组织工程研究与临床康复,2007,11(22):4340-4343 [www.zglckf.com/zglckf/ejournal/upfiles/07-22/22k-4340(ps).pdf]
解放军南京军区南京总医院耳鼻咽喉-头颈外科,江苏省南京市 210002
薛 飞★,男,1978年生,江苏省泰州市人,汉族,2003年解放军第四军医大学毕业,硕士,主治医师,主要从事耳鼻咽喉科学基础与临床方面的研究。
fly.xue@263.net
通讯作者:王秋萍,博士,主任医师,解放军南京军区南京总医院耳鼻咽喉-头颈外科,江苏省南京市 210002
Qpwang1016@vip.sina.com
南京总医院医学科研课题重点项目(2004060)*
中图分类号:R318
文献标识码:A
文章编号:1673-8225
(2007)22-04340-04
收稿日期:2006-05-25
修回日期:2007-04-19
(06-50-5-4383/SN·Y)
课题背景:视觉电生理检查是一种可客观评价视功能的方法,其临床应用可提高对视神经间接损伤的早期诊断能力。皮层视觉诱发电位有很多种,图形翻转视觉诱发电位由于波形稳定,个体间变异小而被广泛地用来评价视神经疾患。
应用要点:视神经减压术有利于减轻视神经间接损伤,较早期(损伤后48 h以内)减压可阻止轴突继发性损伤,避免视功能进一步下降,并在一定程度上逆转视功能的损害。
术语解析:视觉诱发电位是视觉信息通过视觉神经系统在视觉形成的最后阶段产生的,是大脑皮质对视觉刺激发生反应的一簇电信号,它反映了视网膜神经节细胞到视皮质的信息传递状况。图形翻转视觉诱发电位观察指标包括NPN曲线主波(P波)的绝对潜伏期、绝对波幅。
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