【摘要】：目的：⑴在靜脈淤血皮瓣不同位置放置負(fù)壓引流管后皮瓣形態(tài)學(xué)變化及差異。⑵不同位置放置負(fù)壓引流管對(duì)于靜脈淤血皮瓣微循環(huán)及皮瓣氧代謝的影響。⑶負(fù)壓吸引與淤血靜脈再通對(duì)于靜脈淤血皮瓣微循環(huán)及氧代謝影響的比較。通過觀察研究負(fù)壓吸引法對(duì)靜脈淤血皮瓣治療后微循環(huán)的變化，探索簡便有效救治靜脈淤血皮瓣的方法，為進(jìn)一步指導(dǎo)臨床工作提供新的思路和理論基礎(chǔ)。 方法： 1實(shí)驗(yàn)動(dòng)物：新西蘭長耳白兔健康清潔級(jí)40只，雌雄各半，體重質(zhì)量2.5~3kg。 2動(dòng)物模型建立：于皮瓣模型制作前三天，各組白兔行5%硫化鈉腹部脫毛，脫毛面積從兩側(cè)腹股溝向上至劍突水平，兩側(cè)脫毛至腋中線范圍內(nèi)，溫水沖洗自然晾干后用紗布?jí)|及彈力網(wǎng)套包扎好，以保溫并防止腹部皮膚與籠網(wǎng)挫傷。鹽酸塞拉嗪（速眠新）和氯胺酮1:1等比例配好，按照0.2ml/kg體重肌肉內(nèi)注射進(jìn)行麻醉，根據(jù)麻醉情況可于1小時(shí)后再次追加0.1ml/kg劑量藥液維持麻醉。麻醉成功后，取仰臥位，將其四肢捆綁于兔臺(tái)上，，捆綁牙線防止咬傷。0.5%碘伏消毒術(shù)區(qū)，于兔下腹部以腹壁下淺靜脈為軸心設(shè)計(jì)軸行皮瓣，面積約12×4cm，并依據(jù)分組對(duì)相應(yīng)血管進(jìn)行處理。 3實(shí)驗(yàn)動(dòng)物分組：每只新西蘭長耳白兔做兩個(gè)下腹部皮瓣，采用隨機(jī)數(shù)字分配法，將80個(gè)皮瓣分為4組，即對(duì)照組，近端引流組，遠(yuǎn)端引流組和靜脈再通組。每組共20個(gè)皮瓣，每組內(nèi)再采用隨機(jī)數(shù)字分配法將每組20個(gè)皮瓣分為掃描皮瓣12個(gè)，取材皮瓣8個(gè)。 4激光多普勒掃描：采用丹麥產(chǎn)lasa激光多普勒微循環(huán)圖像儀進(jìn)行兔腹部皮瓣的掃描。分別掃描手術(shù)后2h、4h、8h、24h、3d和7d的結(jié)果。 5取材：4個(gè)組共計(jì)取材皮瓣32個(gè)，取材選擇于術(shù)后即刻、4h、8h、24h、3d、7d六個(gè)時(shí)間點(diǎn)，將皮瓣分成上、中、下三個(gè)區(qū)域，于各個(gè)區(qū)域同一時(shí)間點(diǎn)分別切取0.5×0.5cm皮膚。 6檢測方法及觀測指標(biāo)： 6.1激光多普勒掃描成像儀掃描皮瓣特定區(qū)域，記錄皮瓣微循環(huán)血流量數(shù)據(jù)結(jié)果。 6.2皮瓣組織丙二醛（Maleic Dialdehyde MDA）分光光度法監(jiān)測：對(duì)取樣組織首先進(jìn)行勻漿處理，將勻漿組織進(jìn)行水浴離心后，取上清液，依照南京建成MDA試劑盒要求，進(jìn)行分光光度計(jì)比色，測算MDA含量。 7統(tǒng)計(jì)學(xué)處理：所有實(shí)驗(yàn)數(shù)據(jù)以均數(shù)±標(biāo)準(zhǔn)差（x±s）表示，采用spss13.0進(jìn)行檢驗(yàn)，顯著性分析以p 0.05為差異具有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1大體觀察結(jié)果：皮瓣制備后4小時(shí)，各組皮瓣均出現(xiàn)腫脹，皮瓣遠(yuǎn)端呈現(xiàn)暗紫色，對(duì)照組腫脹最為明顯，腫脹面積最大；24小時(shí)后各組皮瓣腫脹進(jìn)一步加重，對(duì)照組腫脹進(jìn)一步加重，同時(shí)皮瓣遠(yuǎn)端大約1/3面積顏色呈暗紫色，斑片狀黑褐色痂皮形成。 近端引流組和遠(yuǎn)端引流組及靜脈再通組皮瓣腫脹較對(duì)照組輕微，暗紫色面積小。遠(yuǎn)端引流組引流液約為2ml，明顯多于較近端引流組。 3天后各組皮瓣暗紫區(qū)域與正常區(qū)域界限逐漸明顯，近端引流組和遠(yuǎn)端引流組及靜脈再通組皮瓣暗紫區(qū)域明顯小于對(duì)照組皮瓣。7天后皮瓣遠(yuǎn)端部分壞死區(qū)域黑色痂皮形成，界限清楚。 2激光多普勒成像儀結(jié)果： 2.1皮瓣遠(yuǎn)段1/3區(qū)域手術(shù)后4h、8h、24h、3d及7d，近端引流組、遠(yuǎn)端引流組、再通組均與對(duì)照組間皮瓣微循環(huán)血流量數(shù)據(jù)結(jié)果進(jìn)行比較有統(tǒng)計(jì)學(xué)意義（P0.05）。手術(shù)后24小時(shí)，遠(yuǎn)端引流組、再通組分別與近端引流組間比較有統(tǒng)計(jì)學(xué)意義（P0.05）。 2.2皮瓣中1/3區(qū)域手術(shù)后4h、8h、24h、3d及7d，近端引流組、遠(yuǎn)端引流組、再通組均與對(duì)照組間皮瓣微循環(huán)血流量數(shù)據(jù)結(jié)果進(jìn)行比較有統(tǒng)計(jì)學(xué)意義（P0.05）。手術(shù)后3天，遠(yuǎn)端引流組、再通組分別與近端引流組間比較有統(tǒng)計(jì)學(xué)意義（P0.05）。 2.3皮瓣近段1/3區(qū)域手術(shù)后4h、8h、24h、3d及7d，近端引流組、遠(yuǎn)端引流組、再通組均與對(duì)照組間皮瓣微循環(huán)血流量數(shù)據(jù)結(jié)果進(jìn)行比較有統(tǒng)計(jì)學(xué)意義（P0.05）。手術(shù)后3d及手術(shù)后7d，近端引流組、再通組與遠(yuǎn)端引流組間有統(tǒng)計(jì)學(xué)意義（P0.05）。 3丙二醛結(jié)果：經(jīng)測定皮瓣遠(yuǎn)、中、近3個(gè)區(qū)域內(nèi)丙二醛的含量，進(jìn)行比較由遠(yuǎn)段到近段丙二醛含量逐漸降低，術(shù)后4h、8h、24h各組皮瓣遠(yuǎn)、中、近段間丙二醛含量間有統(tǒng)計(jì)學(xué)意義（P0.05）；術(shù)后3d各組皮瓣內(nèi)丙二醛含量達(dá)到峰值，皮瓣遠(yuǎn)端區(qū)域再通組與近端引流組及遠(yuǎn)端引流組間有統(tǒng)計(jì)學(xué)差異（P0.05）。3d之后各組間無統(tǒng)計(jì)學(xué)差異（P0.05）。 結(jié)論： 1負(fù)壓吸引法可以有效減輕靜脈淤血皮瓣的腫脹和淤血范圍。 2靜脈淤血皮瓣早期（術(shù)后3天）可出現(xiàn)皮瓣缺氧而引起氧代謝障礙，皮瓣遠(yuǎn)端區(qū)域缺氧損傷更加明顯，再通淤血靜脈后皮瓣遠(yuǎn)端出現(xiàn)缺氧加重情況，可能為缺血再灌注對(duì)皮瓣造成的二次缺血所導(dǎo)致。 3早期在皮瓣遠(yuǎn)端放置負(fù)壓引流可有效改善皮瓣遠(yuǎn)端的血液循環(huán)；于皮瓣蒂部放置負(fù)壓引流可有效促進(jìn)皮瓣近端的血液循環(huán)，有利于皮瓣近段的后期愈合。在皮瓣遠(yuǎn)端區(qū)域，負(fù)壓吸引與再通淤血靜脈后治療效果無差異，可以有效促進(jìn)皮瓣遠(yuǎn)端的皮瓣后期愈合，提高靜脈淤血皮瓣的救治成活率。
[Abstract]:Objective: To observe the morphological changes and differences of the skin flap after placement of the negative pressure drainage tube in different positions of the venous blood flap. The effect of the negative pressure drainage tube on the microcirculation and the oxygen metabolism of the skin flap in different positions of the skin flap. Comparison of the effects of negative pressure suction and blood stasis on microcirculation and oxygen metabolism in venous congestion skin flap. By observing the changes of the microcirculation after the treatment of the venous congestion skin flap by the study of the negative pressure suction method, the method of simple and effective treatment of the venous congestion flap is explored, and a new train of thought and theoretical basis for further guiding the clinical work is provided. square Method:1 experimental animal:40 healthy clean-grade white rabbits of New Zealand white rabbit, half of male and female, and 2.5 to 2.5 weight of body weight. 3 kg.2 animal model:3 days before the skin flap model was made,5% sodium sulfide in each group was depilated in the abdomen, the area of the epilation was up to the level of the swordhead from the groin on both sides, the two sides were depilated to the middle of the middle line of the axilla, the warm water was washed naturally, and then the gauze pad and the elastic force were used. The net cover is wrapped up to keep the heat and prevent the abdominal skin And the dosage of 0.1 ml/ kg can be further added after 1 hour according to the anesthesia condition. The solution is maintained for anesthesia. After the anesthesia is successful, the supine position is taken, and the four limbs are bound on the rabbit table, and the dental floss is used for preventing the bite. The 0.5% iodine-V disinfection area is designed on the lower abdomen of the rabbit with a superficial vein under the abdominal wall as an axial center, the area is about 12 to 4 cm, and the corresponding blood is based on the grouping. tubes were treated.3 experimental animals: two lower abdominal skin flaps per New Zealand long-ear white rabbit, and 80 flaps were divided into 4 groups, i.e., the control group, the proximal drainage group, the distal drainage group, A total of 20 skin flaps in each group were divided into two groups. and 8.4 laser Doppler scanning: using the lasa laser Doppler microcirculatory image instrument in Denmark The scanning of the abdominal skin flap of rabbits was performed. After the operation, the operation was 2 h,4 h,8 h,24 h, respectively. The results of 3 days and 7 days were divided into four groups:32 of the total skin flaps,4 h,8 h,24 h,3 d and 7 d after operation, and the skin flap was divided into upper, middle and lower three regions, and cut out at the same time point in each region. 0.5 to 0.5 cm skin .6 Test method and observation index: 6.1 The laser Doppler scanning imager scans the specific area of the skin flap. And recording the blood flow data of the micro-circulation blood flow of the skin flap. Carry out the colorimetric analysis of the spectrophotometer and calculate the content of MDA.7 Statistics: All the experimental data are expressed in the mean square standard deviation (x% s), and the test is performed by using the spss13.0. sex analysis The results were as follows:1 general observation:4 hours after the preparation of the skin flap, the skin flap of each group had swelling, the distal end of the flap showed dark purple, the swelling of the control group was the most obvious, the swelling area was the largest, and 24 hours The swelling of the skin flap in the control group was further increased, and the swelling of the control group was further increased, while the distal end of the flap was large Approximately 1/3 of the area is dark purple, and plaque-like black-brown skin is formed. The proximal and distal drainage groups The skin flap of the flow group and the venipuncture group was slightly swollen and the dark purple area was small. The drainage fluid of the distal drainage group was about 2 ml, which was significantly more than that of the proximal drainage group. After 3 days, the dark purple region and the normal area of the skin flap gradually became clear, and the dark purple region of the proximal drainage group and the distal drainage group and the venipuncture group was significantly smaller than that of the control group. Skin flap. The distal part of the skin flap after 7 days The black skin of the necrotic area was formed and the boundary was clear. The results of the laser Doppler imaging were as follows: 2.1 The distal segment 1/3 of the skin flap was 4 h,8 h,24 h,3 d and 7 d after the operation, and the proximal drainage group, the distal drainage group, the re-communication group and the control group. The data of the microcirculatory flow of the skin flap was statistically significant (P <0.05). The distal end of the flap was 24 hours after the operation. There was a statistically significant difference between the drainage group and the other group (P0.05). The 1/3 area of the flap was 4 h,8 h,24 h,3 d and 7 d after the operation, and the proximal drainage group, the distal drainage group and the re-passage group were compared with those of the proximal drainage group. The data of the microcirculatory blood flow in the control group was statistically significant (P0.05). There was a significant difference between the two groups in the distal drainage group and the proximal drainage group (P0.05). The data of the microcirculatory blood flow of the flap in the control group was statistically significant (P0.05). The content of malondialdehyde (MDA) in the proximal drainage group, the proximal drainage group, the reperfusion group and the distal drainage group was statistically significant (P0.05). The results of the malondialdehyde (MDA) were as follows: the content of the malondialdehyde (MDA) in the distal, middle and proximal regions of the skin flap was gradually decreased, and the content of the MDA in the proximal section and the proximal section was gradually decreased, and 4 hours after the operation. The content of malondialdehyde (MDA) in the distal region of the skin flap reached the peak, and the distal region of the flap was connected with the proximal drainage group and the distal drainage group. flow group There was a statistical difference (P0.05). There was no statistical difference between the groups after 3 d. Conclusion: The first negative pressure suction method can effectively reduce the swelling and blood stasis of the venous congestion skin flap. The early (3 days after operation) of the venous congestion flap may cause the oxygen metabolism disorder caused by the hypoxia of the skin flap, and the oxygen-deficient injury in the distal region of the skin flap is more clear. In the early stage, the distal end of the skin flap was placed with negative pressure drainage, which could effectively improve the distal flap. The blood circulation at the end of the skin flap is effectively promoted, the blood circulation at the proximal end of the skin flap can be effectively promoted, the later healing of the proximal end of the skin flap is facilitated, and the negative pressure suction and the recanalization are in the far-end region of the skin flap.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R-332

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 劉永紅;不同位置的負(fù)壓吸引法對(duì)靜脈淤血皮瓣微血管的影響[D];河北醫(yī)科大學(xué);2013年

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