發(fā)布時(shí)間：2018-01-12 11:42

  本文關(guān)鍵詞：主動脈套環(huán)吻合技術(shù)的急性動物實(shí)驗(yàn)研究　出處：《南華大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 血管吻合 主動脈套環(huán) 主動脈

【摘要】：目的為了檢驗(yàn)主動脈套環(huán)吻合方法是否在操作耗時(shí)，術(shù)后吻合口出血發(fā)生率優(yōu)于普通針線吻合。 方法選擇體重在15-20kg，年齡2-5歲、健康狀況良好的雜種犬15只。用套環(huán)吻合方法吻合主動脈的雜種犬為實(shí)驗(yàn)組，用普通方法吻合主動脈的雜種犬為對照組。預(yù)實(shí)驗(yàn)5只（根據(jù)實(shí)驗(yàn)的情況對主動脈套環(huán)的設(shè)計(jì)進(jìn)行改進(jìn)，先后進(jìn)行了5次預(yù)實(shí)驗(yàn)），正式實(shí)驗(yàn)10只，雌雄不限，隨機(jī)分實(shí)驗(yàn)組5只，對照組5只。所有實(shí)驗(yàn)犬均在氣管插管全麻下行正中開胸建立體外循環(huán)。停跳液為冷晶體停跳液。記錄體外循環(huán)時(shí)間，主動脈阻斷時(shí)間，血管吻合時(shí)間。實(shí)驗(yàn)組采用主動脈套環(huán)吻合方法。主動脈套環(huán)吻合方法屬于機(jī)械性血管吻合技術(shù)的一種。經(jīng)過5次預(yù)實(shí)驗(yàn)，反復(fù)改進(jìn)套環(huán)設(shè)計(jì)及手術(shù)操作，目前初步成型。套環(huán)吻合裝置分為3部分：近心端套環(huán)，人工血管，遠(yuǎn)心端套環(huán)。套環(huán)動物實(shí)驗(yàn)采用不銹鋼材料。近心端套環(huán)近心一端有2個(gè)U缺口（中心相隔套環(huán)1/3圓周），套環(huán)邊緣打孔數(shù)個(gè)；套環(huán)遠(yuǎn)心一端為寬凹槽。遠(yuǎn)心端套環(huán)僅有一個(gè)寬凹槽。其吻合原理為:實(shí)驗(yàn)前預(yù)先將套環(huán)套入相同口徑人工血管中，近心端套環(huán)用6X14滌綸線通過套環(huán)的孔及7號黑絲線結(jié)扎于寬凹槽固定人工血管及套環(huán)，遠(yuǎn)心端用7號黑絲線直接結(jié)扎固定，近心端2個(gè)U形缺口處去除部分人工血管；實(shí)驗(yàn)時(shí)將預(yù)制好的套環(huán)及人工血管組件近心端兩個(gè)2個(gè)U形缺口對應(yīng)狗的左右冠狀動脈開口，予滌綸針線穿過缺口間的孔縫在主動脈根部(盡可能縫在主動脈瓣環(huán)上)，，穿過主動脈壁打結(jié)，置入組件近心端，于7號絲線結(jié)扎固定組件；同法連接遠(yuǎn)心端套環(huán)。具體如下： 實(shí)驗(yàn)組（套環(huán)吻合）：實(shí)驗(yàn)犬心臟停跳后，在竇管交界上1cm剪開主動脈，方法同上。心臟復(fù)跳后，觀察套扎處有無出血。并記錄體外循環(huán)時(shí)間，主動脈阻斷時(shí)間，主動脈套扎吻合時(shí)間，停機(jī)時(shí)的心率、平均動脈壓。對照組(傳統(tǒng)吻合)：于心臟停跳后，剪除部分升主動脈，用人工血管吻合主動脈。心臟復(fù)跳后，觀察吻合口有出血量。記錄體外循環(huán)時(shí)間，主動脈阻斷時(shí)間及主動脈套扎吻合時(shí)間，停機(jī)時(shí)的心率、平均動脈壓。結(jié)果實(shí)驗(yàn)組：體外循環(huán)時(shí)間分別為：9，8，8，7，6min；主動脈阻斷時(shí)間分別為：4.5，4，4，3.5，3min；主動脈套扎吻合時(shí)間分別為：4，3.5，3.5，3，2.5min；停機(jī)時(shí)的心率分別為：160,179,170,172,165次/min；停機(jī)時(shí)的平均動脈壓分別為：106,100,108,112,104mmHg。對照組：體外循環(huán)時(shí)間分別為：17，16，17，18，18min；主動脈阻斷時(shí)間分別為：8.5，8，8.5，9，9min；主動脈吻合時(shí)間分別為：8，7.5，8，8.5，8min；停機(jī)時(shí)的心率分別為：172,170,167,168,173次/min；停機(jī)時(shí)的平均動脈壓分別為：102,108,107,103,105mmHg。所有實(shí)驗(yàn)犬開放循環(huán)后心臟均能成功復(fù)跳。 結(jié)論主動脈套環(huán)吻合方法吻合操作時(shí)間短，術(shù)后吻合口出血發(fā)生率低，明顯優(yōu)于主動脈普通針線吻合；主動脈套環(huán)對冠狀動脈灌注無影響。
[Abstract]:Objective to investigate whether aortic ring anastomosis is time-consuming, the incidence of postoperative anastomotic bleeding is better than that of common needle and thread anastomosis. Methods Fifteen mongrel dogs with a body weight of 15-20 kg, ages 2-5 years old and good health condition were selected as experimental group, which were anastomosed with aorta by ring anastomosis. Five mongrel dogs with common aortic anastomosis were used as control group. (according to the experimental conditions, the design of aortic ring was improved, 5 times of pre-experiment and 10 cases of formal experiment were carried out. Male and female were randomly divided into experimental group (n = 5) and control group (n = 5). Cardiopulmonary bypass (CPB) was established in all dogs under general anesthesia under tracheal intubation. The cardiopulmonary bypass (CPB) was recorded in the cardiopulmonary bypass (CPB) solution. Aorta occlusion time and vascular anastomosis time. Aortic ring anastomosis was used in the experimental group. Aortic ring anastomosis was one of the mechanical vascular anastomosis techniques. The design and operation of the ring were improved repeatedly. The ring anastomosis device is divided into three parts: the proximal ring and the artificial blood vessel. Ring at the distal end. Stainless steel is used in the animal experiment of the ring. There are two U notches at the proximal end of the ring (the center is separated from the ring by 1/3 circumference and several holes are made at the edge of the ring; The ring has a wide groove at the distal end of the ring and only one wide groove at the distal end of the ring. The matching principle is that the ring is placed in the same diameter artificial blood vessel in advance before the experiment. The proximal ring was fixed with 6X14 polyester thread through the hole of the ring and the No.7 black silk wire was ligated to the wide groove to fix the artificial blood vessel and ring, and the distal end was directly ligated with the 7 # black wire. Two U-shaped notches at the proximal end of the heart removed some of the artificial blood vessels. In the experiment, two U-shaped gaps of the prefabricated ring and the proximal end of the artificial vascular module were matched to the left and right coronary artery openings of the dog. Give polyester thread through the hole between the holes in the root of the aorta (as far as possible sewn in the aortic annulus, through the aortic wall knot, into the proximal end of the component, ligation of the fixed assembly at the 7th silk thread; Connect the concentric ring with the same method. The details are as follows: In the experimental group (ring anastomosis: after cardiac arrest, the aorta was cut 1 cm above the junction of the sinus canal. Methods after resuscitation, the bleeding was observed and the time of cardiopulmonary bypass was recorded. Aortic clamping time, aortic ligation and anastomosis time, heart rate at rest, mean arterial pressure. Control group (traditional anastomosis: after cardiac arrest, cut off part of ascending aorta. Aortic anastomosis was performed with artificial blood vessels. After cardiac resuscitation, the amount of bleeding in anastomotic stoma was observed. The time of extracorporeal circulation, the time of aortic occlusion, the time of aortic ligation and anastomosis, and the heart rate at the time of stopping were recorded. Results the mean arterial pressure in the experimental group: the time of cardiopulmonary bypass (CPB) was 7 minutes. The aortic clamping time was 4: 4.5, 4? 3? 5??? The time of aortic ligation and anastomosis was 2.5 min; The heart rate was 165 / min at 1: 160, 179 / 170 / 172g / min, respectively. The mean arterial pressure at the end of the operation was 10 / 106 / 100 / 108t / 1012 / 104mm / g, respectively. In the control group, the CPB time was 1 / 1716 / 100 / 100 / 108mm / 104mm / g, respectively, and the time of CPB was 18min / min, respectively. The aortic clamping time was 8. 5 and 8. 5 and 9 minutes, respectively. The anastomosis time of aorta was 8: 8 min. The heart rate at downtime was 1: 172, 170, 167, 168, 173 / min, respectively. The mean arterial pressure at the end of the operation was 10 / 102 / 108 / 107 / 103mm / 105mm Hg.All the dogs were able to repulse successfully after open circulation. Conclusion the operation time of aortic ring anastomosis is short, and the incidence of anastomotic bleeding is lower, which is better than that of common aortic needle and line anastomosis, and the aortic ring has no effect on coronary artery perfusion.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R-332

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