局部应用地塞米松在喉返神经损伤后的作用探讨  

Exploration of the role of topical dexamethasone after injury to the recurrent laryngeal nerve

作　　者：吴楷元 黄琦[1] 邬振华[1] 谢如姣 周磊 王淼 WU Kaiyuan;HUANG Qi;WU Zhenhua;XIE Rujiao;ZHOU Lei;WANG Miao(Department of Otolaryngology Head and Neck Surgery,Lihuili Hospital,Ningbo Medical Center,Ningbo,Zhejiang,315000,China)

机构地区：[1]宁波市医疗中心李惠利医院耳鼻咽喉头颈外科,浙江宁波315000

出　　处：《中国耳鼻咽喉头颈外科》2023年第2期121-125,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的应用电生理学和病理组织形态学的方法,探讨局部应用地塞米松凝胶在喉返神经损伤后的近期及远期功能恢复的影响。方法将健康新西兰大白兔随机分为A1、A2、B、C、D、E六组,每组各5只,均暴露左侧第四气管环处喉返神经。(1)按负压吸引力大小分组:A1、A2组未进行负压吸引损伤,为对照组;B、C两组给予0.02 Mpa负压吸引,为低负压组;D、E两组给予0.1 Mpa负压吸引,为高负压组。(2)按神经损伤后处理因素分组:A1组、B组、D组三组均给予5 mg生理盐水处理,为生理盐水组;A2组、C组、E组三组均给予5 mg地塞米松处理,为地塞米松组。六组实验对象分别在喉返神经损伤前、损伤即刻、损伤给药后30 min进行喉返神经监测仪检测喉返神经功能。在术后第8周切取环杓后肌,通过HE、AchE染色来观察其病理形态变化,并对环杓后肌运动终板灰度值进行统计分析。结果(1)环杓后肌AchE染色病理变化:A1组和A2组、B组和C组、D组和E组环杓后肌运动终板灰度值分别为:0.654±0.086 vs 0.652±0.043、0.653±0.034 vs0.652±0.023、0.623±0.021 vs 0.623±0.033,相同负压组间t分别为0.504、0.559、0.418,P均>0.05,说明地塞米松未对实验结果产生影响;生理盐水组和地塞米松组分别采用单因素方差分析,差异有统计学意义(F=53.239、118.726,P均<0.05),说明负压吸引会对神经造成损伤。(2)喉返神经监测仪检测变化:B、C、D、E四组喉返神经检测数值在损伤前和损伤即刻相比差异均>50%,并且四组在损伤即刻和损伤给药后30 min相比无明显差异。结论负压吸引可致喉返神经损伤,负压吸引力是影响喉返神经功能的关键因素,数值越大对喉返神经造成的损伤越严重。局部单次应用小剂量地塞米松对负压吸引导致的喉返神经损伤后的功能恢复并无意义。OBJECTIVE To investigate the effect of local application of dexamethasone gel on short-term and long-term functional recovery after recurrent laryngeal nerve injury by electrophysiological and histopathological methods.METHODS Healthy New Zealand white rabbits were randomly divided into A1,A2,B,C,D,E six groups,five in each group.1.Grouped according to the size of negative pressure attraction:group A1 and group A2 were not injured by negative pressure attraction as control group;B and C groups were given 0.02 Mpa negative pressure suction,which was a low negative pressure group;group D and group E were given 0.1 Mpa negative pressure suction as high negative pressure group.2.Grouped according to the post-processing factors of nerve injury:group A1,group B and group D were treated with 5 mg normal saline as normal saline group;group A2,group C and group E were treated with 5 mg dexamethasone as dexamethasone group.The recurrent laryngeal nerve function of the six groups was detected by recurrent laryngeal nerve monitor before recurrent laryngeal nerve injury,immediately after injury and 30 minutes after injury.The posterior cricoarytenoid muscle was cut at the 8th week after operation,and the pathological changes were observed by HE and AchE staining,and the gray value of the motor endplate of the posterior cricoarytenoid muscle was statistically analyzed.RESULTS 1.Pathological changes in AchE staining of the posterior cricoarytenoid muscle:grey scale values of the motor end plates of the posterior cricoarytenoid muscle in groups A1 and A2,B and C,D and E were 0.654±0.086 vs 0.652±0.043,0.653±0.034 vs 0.652±0.023,0.623±0.021 vs 0.623±0.033 and independent samples t-test between the same negative pressure groups respectively,t value were 0.504,0.559,0.418,respectively and all P>0.05,and indicated that dexamethasone did not affect the results of the experimental;One-way ANOVA was used for the normal saline group and dexamethasone groups,respectively,and the differences were statistically significant(F=53.239,1

关 键 词：喉返神经 神经损伤 地塞米松 环杓后肌 

分 类 号：R653[医药卫生—外科学]