- 學位論文
治療用聲波對於周邊神經之影響
The Therapeutic Effects of Acoustic Waves on Peripheral Nerves
摘要
治療用聲波（therapeutic acoustic wave）包含體外震波治療（extracorporeal shock wave therapy）、物理治療用超音波（therapeutic ultrasound）與高能聚焦超音波治療（high intensity focused ultrasound）等，近來多運用於軟組織的治療，更有學者進一步應用於治療中樞神經疾病所引起之肢體痙攣與周邊神經的燒灼。然而，治療機轉尚不明確而且治療模式尚未建立，對於周邊神經除破壞外，是否會造成其它的效果也不得而知。故本研究利用動物實驗探討震波及超音波治療對於周邊神經之影響，可進一步的使用於治療痙攣或者是周邊神經引起之疼痛。另外，也利用治療用聲波配合止痛藥物，以經皮導入的方式，加速藥物達到止痛的效果。 首先乃在了解震波及高能聚焦超音波是否有神經阻斷效果及其可逆性，以震波或高能聚焦超音波施於大鼠之坐骨神經，並分析其神經電生理信號、功能性評估、以及神經切片之形態變化，了解不同治療劑量對周邊神經的影響；結果顯示震波治療可造成神經傳導速度短暫的小幅下降，並且不影響功能性動作，顯示了震波治療對周邊神經的高安全性，而高能聚焦超音波可造成神經傳導的阻斷長達一個月。 此文，本文亦研究震波與超音波治療對於促進藥物吸收之影響，並提出以神經電生理信號分析評估止痛藥物導入效果之方法。結果顯示震波治療對於促進藥物吸收之效果並不如超音波治療顯著，超音波導入止痛藥物將可應用於表面神經之麻醉，而達到止痛之效果，神經電生理信號評估並也達到客觀分析止痛藥物導入之效果，大幅改進目前無法量化之研究方式。
並列摘要
The use of therapeutic acoustic waves in extracorporeal shock wave therapy (ESWT), therapeutic ultrasound and high intensity focused ultrasound (HIFU) were found to be effective in many clinical fields. Recently, ESWT was shown to be effective in reducing muscle tone among stroke patients. HIFU was also used to ablate peripheral nerve of rat in order to reduce spasticity and pain. However, the mechanism, treatment protocols, and biological effects of acoustic wave on peripheral nerve still remained unknown. On the other side, combined acoustic wave and drug treatment such as sonophoresis is also helpful. Some researchers suggested that the nerve function could be altered by sonophoresis but still lacking a clarify protocol to implement. The purpose of this dissertation was to explore: (1) the direct effects of shockwave and ultrasound on peripheral nerve; and (2) the quantitative effect of sonophoresis on peripheral nerve, both via animal studies. The goal of first study was to clarify the effect of shockwave and HIFU lay on the nerve blockade and its reversibility. Shockwave or HIFU was applied on the sciatic nerve of rats. The electrophysiological and microscopic changes were observed and the functional index of nerve was evaluated under different intensity, frequency, and treatment duration. Collected results indicated that shockwave can induce reversible segmental demyelination in large-diameter fibers, with the electrophysiological changes being positively related to the intensity of the shockwaves. There were no significant changes in functional tests between sham and shockwave treatment groups. Besides, HIFU treatment could block the nerve conduction and affect the functional activities of rats for at least one month. Next, the transdermal drug delivery of shockwave and therapeutic ultrasound was investigated. A new method for evaluating the effect of sonophoresis in analgesic drug objectively was also conducted. The results suggested that the therapeutic ultrasound was effective as a carrier of transdermal drug delivery in promoting the surface anesthesia of analgesic drug. However, the shockwave sonophoresis was not as effective as ultrasound. The electrophysiological method also achieved the goal of quantifying the sonophoresis of analgesic drug objectively.
參考文獻
延伸閱讀
- 趙文鴻、林祈佑、李正民、闕翊芬（2015）。聲音刺激對於大腦不同部位腦波反應之研究。元培學報，(22)，15-28。https://www.airitilibrary.com/Article/Detail?DocID=10287086-201512-201609200004-201609200004-15-28
- Su, M. J. (2021). 【論文摘要】超音波治療對激痛點或肌筋膜疼痛症候群的治療效果－系統性回顧與統合分析. 物理治療, 46(4), 296-296. https://doi.org/10.6215/FJPT.202112.O22
- 崔博翔（2001）。神經組織受超音波刺激後之反應探討〔碩士論文，中原大學〕。華藝線上圖書館。https://doi.org/10.6840/cycu200100393
- 張景淳（2005）。The Modeling and Application of Surface Acoustic Wave Device〔碩士論文，中原大學〕。華藝線上圖書館。https://doi.org/10.6840/cycu200500757
- 黃立中（2012）。Isolation of Acoustic Waves in a Sensor Array Utilizing Phononic Crystals〔碩士論文，大同大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0081-3001201315112804