本文關(guān)鍵詞：兔耳透明質(zhì)酸動脈栓塞模型的建立及透明質(zhì)酸酶溶栓效果的評估　出處：《北京協(xié)和醫(yī)學(xué)院》2016年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 透明質(zhì)酸 動脈栓塞 透明質(zhì)酸酶 靜脈溶栓 選擇性動脈溶栓

【摘要】：一、研究目的1.掌握兔頸部和耳部血管解剖走行和分布情況,為建立兔耳島狀皮瓣和經(jīng)頸外動脈選擇性溶栓治療奠定解剖學(xué)基礎(chǔ)。2.制作兔耳島狀皮瓣,為建立以此為基礎(chǔ)的透明質(zhì)酸(hyaluronic acid, HA)動脈栓塞皮膚缺血模型奠定基礎(chǔ)。3.建立兔耳島狀皮瓣HA動脈栓塞皮膚缺血模型,比較不同劑量HA動脈栓塞后皮瓣再灌注面積的差異,觀察血管的病理學(xué)改變。4.驗(yàn)證血管內(nèi)應(yīng)用透明質(zhì)酸酶(hyaluronidase, HAase)治療HA動脈栓塞皮膚缺血性病變的效果,比較全身靜脈溶栓和選擇性動脈溶栓療效的差異。二、研究方法1.實(shí)驗(yàn)白兔8只,通過化學(xué)性血管鑄型的方法,制作頭頸部血管鑄型標(biāo)本,觀察頸部和耳部血管解剖情況。2.實(shí)驗(yàn)白兔5只,制作2.5×6cm、以耳廓后動脈及耳后靜脈內(nèi)側(cè)支為蒂的島狀皮瓣。術(shù)后4h、24h、3天、5天和7天行熒光血管造影(fluorescein angiography,FA)檢查,觀察皮瓣灌注和成活情況。3.實(shí)驗(yàn)白兔18只,制作島狀皮瓣后,經(jīng)耳廓后動脈注射HA,根據(jù)注射量不同分為10 μl、20 μ1和40 μl組。術(shù)后4h、24h、3天、5天和7天行FA檢查,比較三組在相同時間點(diǎn)皮瓣灌注面積百分比的差異。觀察各組術(shù)后24h和7天時血管病理改變。4.實(shí)驗(yàn)白兔20只,首先制作20μlHA動脈栓塞皮膚缺血模型,根據(jù)治療方式不同分為4組：生理鹽水全身靜脈溶栓對照組(IVT-NaCl組)、HAase全身靜脈溶栓治療組(IVT-HAase組)、生理鹽水選擇性動脈溶栓對照組(IAT-NaCl組)、HAase選擇性動脈溶栓治療組(IAT-HAase組),選擇性動脈溶栓是通過舌動脈/面動脈/舌面干向頸外動脈主干置管完成的,術(shù)后4h、3天和7天行FA檢查。將論文第三部分內(nèi)容中20μl組的結(jié)果作為單純栓塞對照組(Control組),比較五組術(shù)后7天皮瓣灌注面積百分比的差異。三、研究結(jié)果1.枕動脈、顳淺動脈、上頜動脈、面動脈和舌動脈是兔頸外動脈的5個主要分支,雖然它們在頸外動脈發(fā)出的位置存在較大的解剖變異,但發(fā)出后各自的走行方向恒定。兔耳為多源性血供模式,起源于耳后動脈的耳廓后動脈是最為重要的供血動脈,在耳廓近端與耳后靜脈內(nèi)側(cè)支伴行。2.成功建立以耳廓后動脈和耳后靜脈內(nèi)側(cè)支為供血動脈和回流靜脈的兔耳島狀皮瓣,術(shù)后皮瓣灌注良好并完全成活。3.術(shù)后4h,FA檢查熒光斑駁、強(qiáng)弱不等,無法計算灌注面積。除術(shù)后24h 10 u 1組皮瓣灌注面積百分比與20 μl組結(jié)果相比無明顯差異外,其它所有時間點(diǎn)10μl組結(jié)果均顯著性高于20 u 1組,20μl組結(jié)果亦顯著性高于40μl組(P0.05)。HA阻塞處的動脈和靜脈可有嗜酸性粒細(xì)胞浸潤。術(shù)后7天觀察,蒂部被HA栓塞的耳廓后動脈自行再通。4.術(shù)后7天,Control組、IVT-NaCl組、IVT-HAase組、IAT-NaCl組、IAT-HAase皮瓣平均灌注面積百分比分別為76.54±6.92、74.08±9.14、76.94±6.68、76.95±8.72和95.47±3.38。IAT-HAase組皮瓣灌注面積百分比顯著性高于其它四組(P0.05),其它四組結(jié)果兩兩相比均無明顯差異。四、結(jié)論1.頸外動脈的分支情況具備經(jīng)舌動脈/面動脈/舌面干向頸外動脈主干置管、對顳淺動脈分支進(jìn)行選擇性動脈溶栓治療的條件。耳廓血管解剖具備以耳廓后動脈和耳后靜脈內(nèi)側(cè)支作為供血動脈和回流靜脈制作島狀皮瓣的條件。2.兔耳島狀皮瓣灌注良好、完全成活,可以以此為基礎(chǔ)制作HA動脈栓塞皮膚缺血模型。3.成功建立HA動脈栓塞皮膚缺血模型。動脈被完全栓塞后,皮瓣將出現(xiàn)不同程度的再灌注,術(shù)后同一時間,栓塞劑量越大,皮瓣再灌注范圍越小,皮瓣壞死面積越大。被HA栓塞的動脈是有自行再通可能的。HA動脈栓塞可引起血管炎。4. HAase選擇性動脈溶栓能夠有效改善HA動脈栓塞引起的皮瓣缺血、增加組織灌注、縮小皮瓣壞死面積。HAase全身靜脈溶栓的療效有待進(jìn)一步研究。
[Abstract]:A study, 1. master of rabbit neck and ear vascular anatomic distribution and, for the establishment of rabbit ear flap and external carotid artery by selective thrombolytic therapy lay the anatomical basis of.2. rabbit ear flap, for the establishment of hyaluronic acid based (hyaluronic acid HA) embolization skin ischemia model.3. lay the foundation to establish the rabbit ear flap artery embolism HA skin ischemia model, comparison of different doses of HA after embolization flap perfusion difference area, change the.4. to verify the intravascular hyaluronidase pathological observation vessels (hyaluronidase, HAase) for the treatment of HA artery embolism skin ischemic lesion effect, comparison of intravenous thrombolysis and selective arterial thrombolysis treatment. Two research methods 1. experimental 8 rabbits by chemical method of vascular cast, making cast specimens of head and neck vascular, observe the neck and ears Department of vascular anatomy experiment.2. 5 rabbits, making 2.5 * 6cm, the posterior auricular artery and the medial branch of the posterior auricular vein pedicled island flap after operation. 4h, 24h, 3 days, 5 days and 7 days after angiography (fluorescein angiography FA) examination, observation of flap perfusion and survival.3. the 18 white rabbits, making the island flap, the posterior auricular artery injection of HA, according to the different injection volume is divided into 10 L, 20 1 and 40 l group. After 4h, 24h, 3 days, 5 days and 7 days after the FA examination, the difference between the three groups at the same time points of flap perfusion the area percentage were observed. After 7 days of 24h and vascular pathological changes in.4. experiment, 20 rabbits produced the first 20 lHA artery skin ischemia model, according to the different treatment methods were divided into 4 groups: normal saline intravenous thrombolysis group (IVT-NaCl group), HAase intravenous thrombolytic therapy group (IVT-HAase group) saline, selective Arterial thrombolysis group (IAT-NaCl group), HAase selective arterial thrombolysis treatment group (IAT-HAase group), selective arterial thrombolysis through lingual artery / face / artery truncus linguofacialis to external carotid artery trunk catheter complete, postoperative 4h, 3 days and 7 days after FA examination. The third part of the thesis in 20. L group as a result of the simple embolization control group (group Control), the difference between the 7 day perfusion area percentage were compared between the five groups. Results three, 1. occipital artery, superficial temporal artery, maxillary artery and facial artery, lingual artery is the 5 main branches of the external carotid artery, although anatomy variation they are larger in the external carotid artery from the position, but after the issue of their direction is constant. The rabbit ear for sources of blood supply pattern, auricle originated from the posterior auricular artery artery is one of the most important arteries in the auricle proximal medial branch of the posterior auricular vein and the accompanying.2. successfully established by ear Profile after artery and medial branch of the posterior auricular vein to artery and vein of the rabbit ear flap, flap perfusion and survived completely after.3. 4h, FA fluorescent mottled, different strength can not be calculated. In addition, perfusion area after 24h 10 U 1 flap perfusion group area percentage and 20 mu l results no significant difference, all the other 10 time points of l group, the results were significantly higher than those of 20 U 1 group, 20 l group also was significantly higher than that of 40 l group (P0.05).HA blockage of arteries and veins with eosinophilic infiltration. After 7 days of observation, pedicle by the 7 day, HA plug after ear artery to recanalization after.4. Control group, IVT-NaCl group, IVT-HAase group, IAT-NaCl group, IAT-HAase flap average perfusion area percentages were 76.54 + 6.92,74.08 + 9.14,76.94 + 6.68,76.95 + 8.72 and 95.47 + 3.38.IAT-HAase group flap perfusion area percentage was significant Higher than the other four groups (P0.05), the other four groups of 22 results showed no significant difference. Four branches, 1. conclusions of external carotid artery with the lingual artery / face / artery truncus linguofacialis to external carotid artery trunk catheter, selective arterial thrombolysis treatment condition of the branches of superficial temporal artery vascular anatomy with auricle..2. rabbit ear flap perfusion with posterior auricular artery and the medial branch of the posterior auricular vein artery and vein as making island flap survived completely, well, can serve as a basis for making.3. artery embolization skin ischemia model HA successfully established HA artery embolization skin ischemia model. Artery was completely after embolization, the flap will appear reperfusion in different degree, at the same time, the greater the embolization dose, flap reperfusion is smaller, flap necrosis area larger. HA artery embolization is a self recanalization.HA artery embolization may lead Selective arteriolytic thrombolysis with.4. HAase can effectively improve the ischemia of skin flap caused by HA artery embolization, increase tissue perfusion and reduce the area of flap necrosis..HAase systemic intravenous thrombolysis needs further study.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R-332;R764

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相關(guān)碩士學(xué)位論文 前1條

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本文編號：1360492