过氧化氢溶液在清创过程中冲洗时间的长短对周围神经损伤修复的影响

The effect of time course of hydrogen peroxide solution flush on the recovery of peripheral nerve injury

目的目前国内外关于过氧化氢溶液(H_2O_2)对周围神经损伤修复的影响研究还相对较少。文中旨在探讨H_2O_2在外科清创过程中冲洗不同的时间对周围神经损伤修复的影响。方法选取雄性新西兰大白兔18只,随机分成等渗盐水组(等渗盐水冲洗)、H_2O_21 min组(H_2O_2冲洗1min+等渗盐水冲洗)、H_2O_23 min组(H_2O_2冲洗3min+等渗盐水冲洗),每组6只。建立兔坐骨神经损伤的动物模型,术后12周处死实验动物,于缝合神经处取材,检测运动神经传导速度,观察病理切片HE染色情况,第8、12周分别测定兔坐骨神经功能指数(SFI)并进行比较。结果 H_2O_21 min组、等渗盐水组神经传导速度[(25.89±1.42)、(26.46±1.67)m/s]较H_2O_23 min组[(23.80±2.91)m/s]升高(P<0.05)。病理切片观察可见等渗盐水组鞘膜结构较好;H_2O_21 min组神经纤维结构破坏不明显,髓鞘变性轻;H_2O_23 min组鞘膜结构模糊不清,髓鞘轴突变形明显。术后8周、12周,等渗盐水组SFI[(-43.00±0.82)、(-39.17±0.91)m/s]明显高于H_2O_21 min组[(-49.79±1.47)、(-46.60±0.79)m/s]、H_2O_23 min组[(-51.66±1.27)、(-46.39±0.94)m/s],差异有统计学意义(P<0.05)。术后8周H_2O_21 min组SFI明显高于H_2O_23 min组[(-49.79±1.47)m/s vs(-51.66±1.27)m/s,P<0.05]。结论 H_2O_2溶液对受损的周围神经损伤修复有影响且随着H_2O_2溶液冲洗时间的延长可加重周围神经的损伤。临床外科清创过程中在保证杀菌的前提下应尽可能缩短H_2O_2的作用时间。

Objective Currently, the effect of hydrogen peroxide solution（ H2O2） flush on the recovery of peripheral nerve injury are still undetermined. This study aims to explore the effects of different H2O2 flushing time course on recovery of peripheral nerve injury during surgical debridement. Methods 18 New Zealand male white rabbits were randomly divided into isotonic saline group（isotonic saline flush）, H2O2 1 min group （hydrogen peroxide solution flush 1 min ＋ isotonic saline flush）, H2O2 3 min group （H2O2 flush 3 min ＋ isotonic saline flush. Each group has 6 rabbits. We established rabbit sciatic nerve injury model. After 12 weeks, we executed the animals, drew materials at the suture nerve, detected motor nerve conduction velocity and observed pathological HE staining, as well as measuring the sciatic nerve function indexes（SFI） of rabbits at the 8th and 12th week, respectively. Results Nerve conduction velocity in H2O2 1 min group and isotonic saline group[ （ 25.89±1.42）, （26.46±1.67） m/s] were higher than that in the H2O2 3 min group[ （23.80±2.91）m/s] （P〈0.05）. Pathological section shows that the isotonic saline group has a better sheath structure, nerve fibers structure damage is not obvious and myelin degeneration degree is mild in H2O2 1 rain group, blurred sheath structure and myelin axons obvious deformation in H2O2 3min group. 8 weeks and 12 weeks after operation, SFI in isotonic saline group [ （-43.00±0.82）, （-39.17±0.91） m/s] was significant higher than H2O2 1min group [ （-49.79±1.47）, （-46.60±0.79） m/s] and H2O2 3min group [ （-51.66±1.27）, （-46.39±0.94） m/s], the difference was statistically significant （P〈0.05）. SFI in group of H202 l min [ （-49.79± 1.47）m/s ] was higher than group og H2O2 3 min [ （ -51.66±1.27） m/s ] [ P〈0.05 ]. Conclusion H2O2 solution has side effect on the recovery of damaged peripheral nerve injury and with prolonging the H2O2 flushing time, the damage of peripheral nerve can be aggravated. So in the process of clinical surgical debfidement, under the premise of guaranteed sterilization the time of H2O2 flush should be shortened as far as possible.