【作者】 姜彦；

【导师】 李娜；

【作者基本信息】 青岛大学 ， 耳鼻咽喉科， 2003， 硕士

【摘要】 目的 外伤性视神经病（TON）随着目前交通事故的增多而增加，临床上诊断与治疗该病的方法多样，治疗效果各家报道不一，未形成统一的诊治标准，并且缺乏相关的实验研究。尤其在动物实验研究方面，国内研究甚少。我们从建立外伤性视神经病动物模型入手，应用客观的检查方法，建立模拟该病的动物模型，为进一步探讨外伤性视神经病的发病机理、诊治标准及预后提供参考。 方法 选择健康成年家兔2只、家猫2只，处死后解剖观察鼻腔鼻窦及视神经的解剖关系，确定家猫为实验动物。选择健康成年家猫8只，以自身左眼为实验眼，右眼为对照眼，术前检测视觉诱发电位（VISUAL EVOKED POTENTIAL，VEP）。经鼻腔筛蝶窦入路，用自制视神经管损伤器损伤管内段视神经，建立TON模型，检测图形视觉诱发电位（PR-VEP），观察动物瞳孔对光反应。以PR-VEP波形改变为模型建立成功检测的指标。观察动物分别在术后1h、1d、3d、1w、2w、4w时的PR-VEP波形和瞳孔变化。 结果 家猫的鼻窦结构与视神经走行与人类相似，有完整的视神经管，为较适合的实验动物。内镜下经鼻腔鼻窦入路寻找视神经管方法可行。8只猫损伤后有4只瞳孔不同程度散大，直接对光反应减弱或消失，间接对光反应灵敏，但有4只家猫的瞳孔对光反应双侧无明显差异。PR-VEP中N₇₅P₁₀₀、P₁₀₀N₁₄₅波幅均减小，N₇₅、P₁₀₀、N₁₄₅峰潜时均延长。损伤后1h、1d、3d、1w时的N₇₅P₁₀₀、P₁₀₀N₁₄₅波幅分别平均为8.60±1.32uv、7.90±0.39uv；6.81±1.22uv、3.40±0.43uv；6.00±2.07uv、4.50±0.78uv；6.60±1.62uv、3.00±0.78uv。N₇₅、P₁₀₀、N₁₄₅各峰潜时分别平均为82.80±0.69ms、120.60±1.36ms、174.00±2.94ms；106.30±7.14ms、136.80±6.17ms、178.20±7.28ms；101.40±5.68ms、144.60±6.16ms、191.40±9.59ms；106.80±10.08ms、148.80±12.02ms、202.80±12.16ms。损伤后2w与4w时PR-VEP的波形引出为一条近似直线，无法测出各波幅及各峰潜时的数值。损伤前与损伤后1h、1d、3d、1w PR-VEP比较为P＜0.05；1h与1d、3d、1w比较P值＜0.05，1d、3d、1w之间两两比较P值＞0.05或＜0.05。 结论 ①家猫的鼻窦结构与视神经走行与人类相似，有完整的视神经管，为较适合的实验动物。②内镜下经鼻腔筛蝶窦入路建立视神经损伤动物模型方法可行；第一章中文摘要③视神经管损伤前、后的VEP改变明显，VEP变化可作为外伤性视神经病动物模型的客观监测指标;瞳孔对光反射不宜作为TON动物模型建立成功与否的检测指标更多还原

【Abstract】 [Objective] Traumatic Optic Neuropathy(TON) was increasing with the traffic accident. The methods of diagnosis and therapy were variable,the consents and the results were not as same as each other and all these were not formed the unity,lacking the basis foundation especially in the study of animal model.We began with establishing TON model and apply the objective examination methods to provide references to the clinical for its mechanism , checking standard , diagnosis and therapy and prognosis. [Methods] 2 rabbits and 2 cats who were health and growned up were killed.Whose nasal cavity, sinus and optic nerve were observed.Domestic cat was the ideal experiment animal.8 cats who were health and growned up were selected.The right eyes were selected as the experiment eyes and the left eyes were selected as the control’s.Pattern Visual Evoked Potential(PR-VEP)was examined before damage.Through the nasal cavity sieve and sphenoid sinus,optic nerve of the pipeline was damaged by the injury tool which was made by ourselves.And animal models of TON were established,the PR-VEP was examined again by which we determined the succeed model.PR-VEP were examined at1h. 1d, 3d, 1w, 2w, 4w after damage.[Results] The paranasal sinus construction and optic nerve of the cat resembled with mankind,the nerve tube was completely and cat was the ideal experiment animal.8 cats’s N75P100, P100N145 amplitude reduced and N75 , P100, N145 peak time prolong at 1h, 1d, 3d, 1w after damage. The N75 P100’S, P100N145’s average amplitude respectively were 8.60 1.32uv, 7.90 0.39uv, 6.82 1.22uv, 3.40 0.43uv and 6.00 2.45uv, 4.50 0.93uv, 6.60 0.54uv, 3.00 0.91uv.The N75’s, P100’S, N145’S average peak time resp-ecttively were 82.80+0.69ms, 120.60+1.36ms, 174.00 2.94ms, 106.20+7.14 ms, 136.80 6.17ms , 178.20 7.28ms,101.40 5.68ms , 144.60 7.28ms , 191.40 11.34ms,106.80 11.93ms, 148.80 14.21ms, 202.80 14.40ms.2w’s and 4w’s PR-VEP waves respectively were smooth threads.PR-VEP before operation comparing to 1h, 1d, 3d, 1w after operation were P<0.05, P<0.05, P,0.05, P<0.05 . PR-VEP of 1h comparing to 1d, 3d, 1w were P<0.05,1d, 3d, 1w compared each other were P>.05 or P<0.05.[Conclusion]This animal model was similar to clinical optic nerve decompression through nasal cavity , sieve and sphenoid sinus.The change of PR-VEP was distinctively before damage and after damage.This showed that this model was successful.And the PR-VEP of different time was different after damage.This was correlated with the effect which was caused by optic nerve decompression operation after injury in different time.The pupil reflects to the light was not proper examination standerd for TON animal model establish the success or not.更多还原