缺氧缺血,脑%运动%神经行为学表现%兔
缺氧缺血,腦%運動%神經行為學錶現%兔
결양결혈,뇌%운동%신경행위학표현%토
Hypoxia ischemia,brain%Movement%Neurobehavioral manifestations%Rabbits
目的 研究改良的神经行为学评估结果量表对新生兔神经行为学评分的效果. 方法 妊娠29 d健康新西兰白兔12只,随机分为3组,每组4只.缺氧缺血25 min组、缺氧缺血28 min组分别阻断孕兔子宫血流25、28 min,对照组不阻断子宫血流.记录新生兔的一般情况.每组活产新生兔随机分为顺向评分亚组、反向评分亚组、改良评分亚组,分别按神经行为学评分量表顺向和反向顺序以及改良的神经行为学评分量表顺向顺序进行评估,记录神经行为学评分结果,比较不同评分方法对评估结果的影响.同时行病理学观察,分析存活新生兔神经行为学得分与缺氧缺血时间和脑细胞凋亡数量的相关性.采用Spearman秩相关检验、单因素方差分析、Kruskal-Wallis H检验、Wilcoxon秩和检验或x2检验进行统计学分析. 结果 对照组和缺氧缺血25、28 min组的死胎率分别为0.0％(0/28)、16.7％(6/31)与37.9％(11/29),x2=21.33,P=0.00;纹状体单位面积内脑细胞凋亡数量逐渐增多[分别为0(0～1)、7(6～10)与25(22～28)个,H=54.39,P＜0.05]；神经行为学得分依次降低[对照组、缺氧缺血25和28 min组相比,姿势:3.00(2.25～3.00)分、2.00(1.00～2.00)分与1.00(1.00～1.00)分,H=38.47;翻正次数:9.00(8.00～9.75)次、4.00(3.00～5.00)次与1.00(0.00～1.00)次,H=52.30;翻正得分:2.90(2.80～2.98)分、2.10(1.90～2.20)分与1.30(1.00～1.40)分,H=53.53;运动能力:3.00(2.00～3.00)分、1.50(1.00～2.00)分与0.00(0.00～1.00)分,H=38.97；吮吸和吞咽协调能力:3.00(2.00～3.00)分、1.50(1.00～2.00)分与1.00(0.00～1.00)分,H=42.87;嗅觉刺激:3.00(3.00～3.00)分、2.00(2.00～2.00)分与1.00(1.00～2.00)分,H=38.43;P均=0.00].反向评分亚组神经行为学得分与顺向评分亚组间存在一定的差异,顺向评分亚组姿势项得分、翻正次数高于反向评分亚组,以对照组和缺氧缺血25 min组孕兔所产新生兔姿势项得分下降最明显[顺向评分亚组与反向评分亚组相比,姿势项:对照组:3.00(3.00～3.00)分与2.00(2.00～3.00)分,T=69.00,P＜0.05；缺氧缺血25 min组:2.00(1.25～2.00)分与1.00(1.00～1.75)分,T=52.00,P＜0.05.翻正次数:缺氧缺血25 min组:4.50(4.00～5.75)次与3.00(2.25～4.00)次,T=47.00,P＜0.05]；反向评分亚组嗅觉刺激项、吮吸和吞咽协调能力项得分略高于顺序评分亚组,但差异无统计学意义(P＞0.05).改良评分亚组各评估项得分与顺向评分亚组相近,表现出高度的一致性(P＞0.05).相关性分析发现,存活新生兔神经行为学评分分别与缺氧缺血时间、纹状体单位面积内脑细胞凋亡数量呈负相关关系(r均＜0,P均＜0.05),其中顺向评分亚组和改良法评分亚组新生兔神经行为学各项得分与缺氧缺血时间、纹状体区域单位面积内凋亡的脑细胞数量间相关系数接近,相关性强(｜r｜≈0.8,P均＜0.05). 结论 对新生兔反复被动运动检查可导致低估新生兔的神经行为学评估结果；经改良的神经行为学量表可准确反映缺氧缺血性脑损伤后新生兔的神经行为学损害程度.
目的 研究改良的神經行為學評估結果量錶對新生兔神經行為學評分的效果. 方法 妊娠29 d健康新西蘭白兔12隻,隨機分為3組,每組4隻.缺氧缺血25 min組、缺氧缺血28 min組分彆阻斷孕兔子宮血流25、28 min,對照組不阻斷子宮血流.記錄新生兔的一般情況.每組活產新生兔隨機分為順嚮評分亞組、反嚮評分亞組、改良評分亞組,分彆按神經行為學評分量錶順嚮和反嚮順序以及改良的神經行為學評分量錶順嚮順序進行評估,記錄神經行為學評分結果,比較不同評分方法對評估結果的影響.同時行病理學觀察,分析存活新生兔神經行為學得分與缺氧缺血時間和腦細胞凋亡數量的相關性.採用Spearman秩相關檢驗、單因素方差分析、Kruskal-Wallis H檢驗、Wilcoxon秩和檢驗或x2檢驗進行統計學分析. 結果 對照組和缺氧缺血25、28 min組的死胎率分彆為0.0％(0/28)、16.7％(6/31)與37.9％(11/29),x2=21.33,P=0.00;紋狀體單位麵積內腦細胞凋亡數量逐漸增多[分彆為0(0～1)、7(6～10)與25(22～28)箇,H=54.39,P＜0.05]；神經行為學得分依次降低[對照組、缺氧缺血25和28 min組相比,姿勢:3.00(2.25～3.00)分、2.00(1.00～2.00)分與1.00(1.00～1.00)分,H=38.47;翻正次數:9.00(8.00～9.75)次、4.00(3.00～5.00)次與1.00(0.00～1.00)次,H=52.30;翻正得分:2.90(2.80～2.98)分、2.10(1.90～2.20)分與1.30(1.00～1.40)分,H=53.53;運動能力:3.00(2.00～3.00)分、1.50(1.00～2.00)分與0.00(0.00～1.00)分,H=38.97；吮吸和吞嚥協調能力:3.00(2.00～3.00)分、1.50(1.00～2.00)分與1.00(0.00～1.00)分,H=42.87;嗅覺刺激:3.00(3.00～3.00)分、2.00(2.00～2.00)分與1.00(1.00～2.00)分,H=38.43;P均=0.00].反嚮評分亞組神經行為學得分與順嚮評分亞組間存在一定的差異,順嚮評分亞組姿勢項得分、翻正次數高于反嚮評分亞組,以對照組和缺氧缺血25 min組孕兔所產新生兔姿勢項得分下降最明顯[順嚮評分亞組與反嚮評分亞組相比,姿勢項:對照組:3.00(3.00～3.00)分與2.00(2.00～3.00)分,T=69.00,P＜0.05；缺氧缺血25 min組:2.00(1.25～2.00)分與1.00(1.00～1.75)分,T=52.00,P＜0.05.翻正次數:缺氧缺血25 min組:4.50(4.00～5.75)次與3.00(2.25～4.00)次,T=47.00,P＜0.05]；反嚮評分亞組嗅覺刺激項、吮吸和吞嚥協調能力項得分略高于順序評分亞組,但差異無統計學意義(P＞0.05).改良評分亞組各評估項得分與順嚮評分亞組相近,錶現齣高度的一緻性(P＞0.05).相關性分析髮現,存活新生兔神經行為學評分分彆與缺氧缺血時間、紋狀體單位麵積內腦細胞凋亡數量呈負相關關繫(r均＜0,P均＜0.05),其中順嚮評分亞組和改良法評分亞組新生兔神經行為學各項得分與缺氧缺血時間、紋狀體區域單位麵積內凋亡的腦細胞數量間相關繫數接近,相關性彊(｜r｜≈0.8,P均＜0.05). 結論 對新生兔反複被動運動檢查可導緻低估新生兔的神經行為學評估結果；經改良的神經行為學量錶可準確反映缺氧缺血性腦損傷後新生兔的神經行為學損害程度.
목적 연구개량적신경행위학평고결과량표대신생토신경행위학평분적효과. 방법 임신29 d건강신서란백토12지,수궤분위3조,매조4지.결양결혈25 min조、결양결혈28 min조분별조단잉토자궁혈류25、28 min,대조조불조단자궁혈류.기록신생토적일반정황.매조활산신생토수궤분위순향평분아조、반향평분아조、개량평분아조,분별안신경행위학평분량표순향화반향순서이급개량적신경행위학평분량표순향순서진행평고,기록신경행위학평분결과,비교불동평분방법대평고결과적영향.동시행병이학관찰,분석존활신생토신경행위학득분여결양결혈시간화뇌세포조망수량적상관성.채용Spearman질상관검험、단인소방차분석、Kruskal-Wallis H검험、Wilcoxon질화검험혹x2검험진행통계학분석. 결과 대조조화결양결혈25、28 min조적사태솔분별위0.0％(0/28)、16.7％(6/31)여37.9％(11/29),x2=21.33,P=0.00;문상체단위면적내뇌세포조망수량축점증다[분별위0(0～1)、7(6～10)여25(22～28)개,H=54.39,P＜0.05]；신경행위학득분의차강저[대조조、결양결혈25화28 min조상비,자세:3.00(2.25～3.00)분、2.00(1.00～2.00)분여1.00(1.00～1.00)분,H=38.47;번정차수:9.00(8.00～9.75)차、4.00(3.00～5.00)차여1.00(0.00～1.00)차,H=52.30;번정득분:2.90(2.80～2.98)분、2.10(1.90～2.20)분여1.30(1.00～1.40)분,H=53.53;운동능력:3.00(2.00～3.00)분、1.50(1.00～2.00)분여0.00(0.00～1.00)분,H=38.97；전흡화탄인협조능력:3.00(2.00～3.00)분、1.50(1.00～2.00)분여1.00(0.00～1.00)분,H=42.87;후각자격:3.00(3.00～3.00)분、2.00(2.00～2.00)분여1.00(1.00～2.00)분,H=38.43;P균=0.00].반향평분아조신경행위학득분여순향평분아조간존재일정적차이,순향평분아조자세항득분、번정차수고우반향평분아조,이대조조화결양결혈25 min조잉토소산신생토자세항득분하강최명현[순향평분아조여반향평분아조상비,자세항:대조조:3.00(3.00～3.00)분여2.00(2.00～3.00)분,T=69.00,P＜0.05；결양결혈25 min조:2.00(1.25～2.00)분여1.00(1.00～1.75)분,T=52.00,P＜0.05.번정차수:결양결혈25 min조:4.50(4.00～5.75)차여3.00(2.25～4.00)차,T=47.00,P＜0.05]；반향평분아조후각자격항、전흡화탄인협조능력항득분략고우순서평분아조,단차이무통계학의의(P＞0.05).개량평분아조각평고항득분여순향평분아조상근,표현출고도적일치성(P＞0.05).상관성분석발현,존활신생토신경행위학평분분별여결양결혈시간、문상체단위면적내뇌세포조망수량정부상관관계(r균＜0,P균＜0.05),기중순향평분아조화개량법평분아조신생토신경행위학각항득분여결양결혈시간、문상체구역단위면적내조망적뇌세포수량간상관계수접근,상관성강(｜r｜≈0.8,P균＜0.05). 결론 대신생토반복피동운동검사가도치저고신생토적신경행위학평고결과；경개량적신경행위학량표가준학반영결양결혈성뇌손상후신생토적신경행위학손해정도.
Objective To study the effect of passive movement test on neurobehavioral score of neonatal rabbit and establish an improved neurobehavioral scoring protocol.Methods Twelve pregnant New Zealand white rabbits were randomly divided into three groups (n =4 in each).In 25 and 28 min ischemic group,uterine blood supply was blocked for 25 min and 28 min respectively,but not in the control group.The general information of neonatal rabbit was recorded.All live birth neonatal rabbits in each group were again randomly divided into forward assessment group,backward assessment group and simplified assessment group.Forward assessment group and backward assessment group were assessed with the published protocol in forward and reverse order respectively,and the simplified assessment group was assessed with improved protocol in forward order.The results of assessment was recorded and the effect of different assessment methods on neurobehavioral score was evaluated.Meanwhile,the pathohistological changes in the brains of neonatal rabbits were observed,and the correlation between the neurobehavioral test score and the duration of intrauterine ischemic and the amount of apoptosis neural cell was analyzed.Spearman rank correlation test,single factor analysis of variance,Kruskal Wallis H test,Wilcoxon signed rank test and Chi-square test were used for statistical analysis.Results The stillbirth rate in control group,25 and 28 min ischemic group was 0.0％(0/28),16.7％(6/31) and 37.9％(11/29) with statistical significance (x2 21.33,P＜0.05).The amount of apoptosis brain cells in the three groups was 0 (0 1),7 (6-10) and 25 (22-28) respectively (x2 54.39,P＜0.05).The neurobehavioral test score in control,25 min and 28 min ischemic group decreased accordingly [Posture:3.00(2.25 3.00),2.00(1.00 2.00) and 1.00(1.00-1.00) (H=38.47,P=0.00); Righting turns (times):9.00(8.00 9.75),4.00(3.00 5.00) and 1.00(0.00 1.00) (H=52.30,P=0.00); Righting score:2.90(2.80-2.98),2.10 (1.90 2.20) and 1.30(1.001.40) (H 53.53,P 0.00); Locomotion:3.00(2.00 3.00),1.50(1.002.00) and 0.00(0.00-1.00) (H=38.97,P=0.00); Sucking and swallowing:3.00(2.00 3.00),1.50(1.00-2.00) and 1.00(0.00 1.00) (H=42.87,P=0.00); Olfactary stimulation:3.00(3.00-3.00),2.00(2.00 2.00) and 1.00(1.00-2.00) (H=38.43,P=0.00)].There were some differences of neurobehavioral test score between backward and forward assessment within individual group.The posture score and the righting times in backward assessment group were generally lower than those in forward assessment group,and significant difference was shown between the control group and 25 min ischemicgroup [Posture:3.00(3.00 3.00) vs 2.00(2.00 3.00),T=69.0,P＜0.05; 2.00(1.25 2.00) vs 1.00(1.001.75),T=52.0,P＜0.05.Righting turns (times):4.50(4.00-5.75) vs 3.00(2.25 4.00),T=47.0,P＜0.05].The score of olfactory stimulation,sucking and swallowing in backward assessment group were a little higher than that in forward assessment group,but the difference was not predominate (P＞0.05).The neurobehavioral test score in simplified assessment group was consistent with the forward assessment group (P＞0.05).Negative correlation was revealed between the neurobehavioral test score,the duration of intrauterine ischemic and the amount of apoptosis brain cells (all r＜0,P＜0.05),and the correlation in simplified assessment group and forward assessment group were close and obvious ｜ r ｜ ≈ 0.8.Conclusions The classical passive movement test may underestimate neurobehavioral manifestation,while the modified neurobehavioral scoring protocol could accurately evaluate the neurobehavioral damage level of neonatal rabbits with hypoxia ischemic brain damage.
