CAJ | 학술논문

背景：近10年来使用皮质电刺激治疗脑卒中的动物和临床试验均得到了比较肯定的结果。 　　目的：观察全植入式皮质电刺激器长时间、低强度、变频皮质电刺激对大鼠局灶性脑梗死后神经功能恢复的影响。 　　方法：成年雄性SD大鼠60只，线栓法制作大脑中动脉阻塞的脑梗死模型。选取Bederson评分为1-3分的大鼠40只进行MRI扫描，筛选出有皮质梗死的大鼠(n=23)，MRI测定梗死灶周边皮质的位点，确定接受皮质电刺激治疗的靶点，大脑中动脉阻塞后第6天植入电刺激器。将23只大鼠随机分为2组：皮质电刺激组(n=13)大鼠每天进行皮质电刺激治疗2次/d，每次持续30 min，电刺激频率10 s内在50，20和5 Hz之间变动并重复循环。无刺激组(n=10)仅植入电刺激器，无电刺激输出。在植入电刺激器后第2天和第16天，两组大鼠进行前肢使用不对称、足失误测试，第16天最后一次行为学评价完成后，取出电刺激器进行检测，常规苏木精-伊红染色观察大鼠梗死灶周围皮质结构及细胞形态。 　　结果与结论：23个电刺激器取出后，仅发现1个皮质电刺激组电刺激器不能正常工作，其余各电刺激器性能均保持良好。除1只大鼠在电刺激器植入部位的皮肤有破溃，愈合稍差，其余大鼠皮肤切口均愈合良好。苏木精-伊红染色可见脑梗死电极植入处皮质组织结构清晰完整，神经细胞排列整齐，神经元胞浆丰富，核仁清楚，正常胶质细胞结构完整，细胞周围间隙致密无水肿。足失误和前肢使用不对称测试结果均显示第16天皮质电刺激组大鼠神经功能恢复显著优于较无刺激组。结果表明采用了一套用于大鼠脑梗死模型的全植入式皮质电刺激器，建立了安全的植入方式及刺激模式，并证明低强度、长时间、变频的脉冲式电刺激模式是安全的，且有助于促进大脑局灶性脑梗死后的神经功能恢复。揹景：近10年來使用皮質電刺激治療腦卒中的動物和臨床試驗均得到瞭比較肯定的結果。 　　目的：觀察全植入式皮質電刺激器長時間、低彊度、變頻皮質電刺激對大鼠跼竈性腦梗死後神經功能恢複的影響。 　　方法：成年雄性SD大鼠60隻，線栓法製作大腦中動脈阻塞的腦梗死模型。選取Bederson評分為1-3分的大鼠40隻進行MRI掃描，篩選齣有皮質梗死的大鼠(n=23)，MRI測定梗死竈週邊皮質的位點，確定接受皮質電刺激治療的靶點，大腦中動脈阻塞後第6天植入電刺激器。將23隻大鼠隨機分為2組：皮質電刺激組(n=13)大鼠每天進行皮質電刺激治療2次/d，每次持續30 min，電刺激頻率10 s內在50，20和5 Hz之間變動併重複循環。無刺激組(n=10)僅植入電刺激器，無電刺激輸齣。在植入電刺激器後第2天和第16天，兩組大鼠進行前肢使用不對稱、足失誤測試，第16天最後一次行為學評價完成後，取齣電刺激器進行檢測，常規囌木精-伊紅染色觀察大鼠梗死竈週圍皮質結構及細胞形態。 　　結果與結論：23箇電刺激器取齣後，僅髮現1箇皮質電刺激組電刺激器不能正常工作，其餘各電刺激器性能均保持良好。除1隻大鼠在電刺激器植入部位的皮膚有破潰，愈閤稍差，其餘大鼠皮膚切口均愈閤良好。囌木精-伊紅染色可見腦梗死電極植入處皮質組織結構清晰完整，神經細胞排列整齊，神經元胞漿豐富，覈仁清楚，正常膠質細胞結構完整，細胞週圍間隙緻密無水腫。足失誤和前肢使用不對稱測試結果均顯示第16天皮質電刺激組大鼠神經功能恢複顯著優于較無刺激組。結果錶明採用瞭一套用于大鼠腦梗死模型的全植入式皮質電刺激器，建立瞭安全的植入方式及刺激模式，併證明低彊度、長時間、變頻的脈遲式電刺激模式是安全的，且有助于促進大腦跼竈性腦梗死後的神經功能恢複。
배경：근10년래사용피질전자격치료뇌졸중적동물화림상시험균득도료비교긍정적결과。 　　목적：관찰전식입식피질전자격기장시간、저강도、변빈피질전자격대대서국조성뇌경사후신경공능회복적영향。 　　방법：성년웅성SD대서60지，선전법제작대뇌중동맥조새적뇌경사모형。선취Bederson평분위1-3분적대서40지진행MRI소묘，사선출유피질경사적대서(n=23)，MRI측정경사조주변피질적위점，학정접수피질전자격치료적파점，대뇌중동맥조새후제6천식입전자격기。장23지대서수궤분위2조：피질전자격조(n=13)대서매천진행피질전자격치료2차/d，매차지속30 min，전자격빈솔10 s내재50，20화5 Hz지간변동병중복순배。무자격조(n=10)부식입전자격기，무전자격수출。재식입전자격기후제2천화제16천，량조대서진행전지사용불대칭、족실오측시，제16천최후일차행위학평개완성후，취출전자격기진행검측，상규소목정-이홍염색관찰대서경사조주위피질결구급세포형태。 　　결과여결론：23개전자격기취출후，부발현1개피질전자격조전자격기불능정상공작，기여각전자격기성능균보지량호。제1지대서재전자격기식입부위적피부유파궤，유합초차，기여대서피부절구균유합량호。소목정-이홍염색가견뇌경사전겁식입처피질조직결구청석완정，신경세포배렬정제，신경원포장봉부，핵인청초，정상효질세포결구완정，세포주위간극치밀무수종。족실오화전지사용불대칭측시결과균현시제16천피질전자격조대서신경공능회복현저우우교무자격조。결과표명채용료일투용우대서뇌경사모형적전식입식피질전자격기，건립료안전적식입방식급자격모식，병증명저강도、장시간、변빈적맥충식전자격모식시안전적，차유조우촉진대뇌국조성뇌경사후적신경공능회복。
BACKGROUND:Cortical electrical stimulation has achieved good effects in treatment of stroke through animal and clinical experiments. OBJECTIVE:To observe the effects of a ful y implanted cortical electrical stimulation device with long time, low intensity and various frequencies stimulation protocols on the neurological function recovery in a rat model of local cerebral infarction. METHODS:The cerebral infarction model was established through middle cerebral artery occlusion in 60 Sprague-Dawley adult male rats. Forty rats with 1-3 points by Bederson scale were detected with magnetic resonance imaging, which was used to confirm cortex infarction and to identify a location for implantation of stimulating electrode over the peri-infarct cortex. Twenty-three rats with cortex infarction were randomly divided into cortical electrical stimulation group (CES group, n=13) and no stimulation group (NS group;n=10). The device was implanted on 6 days after middle cerebral artery occlusion, and the stimulation was given for 16 days. The stimulation program consists of two sessions lasting half an hour each in the morning and in the afternoon respectively. Stimulator delivered biphasic charge balanced pulses (pulse width=200μs) with various frequencies of 50 Hz, 20 Hz and 5 Hz within 10 second blocks and then repeated. The rats of NS group were implanted with the device, but received no electrical stimulation. The behavioral tests, includingforelimb use asymmetry test and foot fault test were performed at 2 and 16 days after implantation. Final y, al of the devices were taken out to test if they were normal y working and al of the rats were sacrificed for hematoxylin-eosin staining, which can reflect the structure of peri-infarct cortex and cellmorphology. RESULTS AND CONCLUSION:There was only one stimulator in CES group cannot normal y work, and the remaining 22 ones worked wel . The skin covered the implanted stimulator was slightly ulcerated in one rat, and the incisions of the other rats were healed wel . Hematoxylin-eosin staining showed clear and intact structure in peri-infarction cortex (i.e., electrodes were implanted at the cortex), neurons arranged in neat rows, with abundant neuronal cytoplasm and clear nucleolus. The glial cells have complete structures, and there was no edema in the intercellular spaces. Foot-fault and forelimb use asymmetry tests showed the improved neurological function in rats of CES group than that of NS group. We designed a ful-implanted cortical electrical stimulator used in cerebral ischemic rats, and established an implanted method with long time, low intensity and various frequencies pulsed electrical stimulation. The results indicated the stimulation pattern in our study is safe and effective, and it can significantly promote functional recovery in local cerebral infarction rats.