發(fā)布時(shí)間：2018-06-17 13:46

  本文選題：房間隔缺損 + 房間隔穿刺術(shù)��； 參考：《昆明醫(yī)學(xué)院》2010年碩士論文

【摘要】： 【目的】:通過X線下介入導(dǎo)管的方法經(jīng)右側(cè)頸外靜脈行房間隔穿刺及球囊擴(kuò)張術(shù)建立豬房間隔缺損動(dòng)物模型,通過右心導(dǎo)管測壓和心臟超聲等手段評(píng)估模型制作的可行性,觀察不同時(shí)期血流動(dòng)力學(xué)和心臟結(jié)構(gòu)的變化。 【方法】:選用由昆明醫(yī)學(xué)院提供的封閉群滇南小耳豬16頭,平均月齡9-10月,體重18-25公斤,雌雄不限。按體重相近隨機(jī)將16頭豬分為兩組,組一:n=4,行房間隔穿刺術(shù);組二:n=12,在成功行房間隔穿刺術(shù)的基礎(chǔ)上,分別采用0.8cm,1.5cm直徑大小的擴(kuò)張球囊先后對(duì)房間隔缺損口擴(kuò)張。將組二隨機(jī)再分成A,B兩組,每組6頭,A組經(jīng)頸外靜脈途徑建立模型,B組經(jīng)股靜脈途徑建立模型。模型建立后比較兩種方法在手術(shù)時(shí)間和X線暴露時(shí)間上的差異,動(dòng)態(tài)觀察實(shí)驗(yàn)豬的一般情況,分別于術(shù)前,術(shù)后即刻,術(shù)后1月及術(shù)后3月通過有創(chuàng)壓力檢測和心臟超聲的方法觀察血流動(dòng)力學(xué)和心臟結(jié)構(gòu)的變化。 【結(jié)果】:16頭健康實(shí)驗(yàn)豬,1頭死于術(shù)中急性心包填塞,3頭豬成功行房間隔穿刺術(shù),術(shù)后即刻,術(shù)后3月經(jīng)心臟超聲和心臟解剖證實(shí)缺損口閉合;其余12頭豬分別經(jīng)頸外靜脈或股靜脈途徑在成功行房間隔穿刺術(shù)基礎(chǔ)上用0.8cm,1.5cm直徑大小的球囊行球囊擴(kuò)張術(shù)成功建立動(dòng)物模型,除1頭在手術(shù)后因感染死亡外,其余11頭存活,分別在術(shù)后即刻,術(shù)后1月,術(shù)后3月經(jīng)心臟超聲和心臟解剖證實(shí)缺損口直徑大小為1.16±0.15cm,1.01±0.14cm,0.91±0.14cm。頸外靜脈途徑建立豬房間隔缺損模型在手術(shù)時(shí)間和X線暴露時(shí)間方面短于股靜脈途徑。有創(chuàng)壓力監(jiān)測顯示術(shù)后3月與術(shù)前比較,平均肺動(dòng)脈壓(MPAP),右心室壓力(RVP),右心房壓力(RAP)差異有顯著性統(tǒng)計(jì)學(xué)意義(P＜0.01),心臟超聲顯示術(shù)后3月與術(shù)前比較,右心房內(nèi)徑(RA),右心室內(nèi)徑(RV),左心房內(nèi)徑(LA)差異有顯著統(tǒng)計(jì)學(xué)意義(P＜0.01),術(shù)后3月行病理檢查發(fā)現(xiàn)疤痕組織形成,心肌細(xì)胞排列整齊,未見明顯的細(xì)胞變性,壞死和纖維組織增生,肺小動(dòng)脈管腔大小正常,無肌化表現(xiàn)。 【結(jié)論】:經(jīng)頸外靜脈行房間隔穿刺術(shù)及球囊擴(kuò)張術(shù)制作豬房間隔缺損動(dòng)物模型是一種有效,簡便,微創(chuàng),可重復(fù)的方法。經(jīng)頸外靜脈途徑行豬房間隔缺損動(dòng)物模型的制作方法在手術(shù)時(shí)間和X線暴露時(shí)間方面短于經(jīng)股靜脈途徑豬房間隔缺損動(dòng)物模型的制作。豬房間隔缺動(dòng)物模型主要影響了右心系統(tǒng)的血液動(dòng)力學(xué)及心臟形態(tài)的變化,是建立左向右分流型肺動(dòng)脈高壓模型的方法之一。
[Abstract]:[objective] to establish an animal model of atrial septal defect (ASD) by transcatheter interventional catheter through right external jugular vein and balloon dilatation, and to evaluate the feasibility of the model by right cardiac catheterization and echocardiography. The changes of hemodynamics and cardiac structure in different periods were observed. [methods] Sixteen small Diannan small ear pigs, which were provided by Kunming Medical College, were selected, with an average age of 9-10 months and weight of 18-25 kg. Sixteen pigs were randomly divided into two groups according to their similar body weight, one group was divided into two groups, the other group was divided into two groups. Group 2 was randomly divided into two groups: group A (n = 6) and group B (n = 6) established a model via external jugular vein and group B (via femoral vein). After the establishment of the model, the differences between the two methods in operation time and X-ray exposure time were compared, and the general situation of experimental pigs was observed dynamically, before and immediately after operation, respectively. The changes of hemodynamics and cardiac structure were observed 1 month after operation and 3 months after operation by invasive pressure test and echocardiography. [results] one of 16 healthy pigs died of acute pericardium during operation. Three pigs were successfully treated with atrial septal puncture. Immediately after operation, the defect was confirmed by echocardiography and cardiac anatomy 3 months after operation. The other 12 pigs were successfully established by balloon dilatation via external jugular vein or femoral vein on the basis of successful atrial septal puncture with a balloon of 0.8 cm or 1.5 cm in diameter. The other 11 pigs survived except one died of infection after operation. The diameter of the defect was 1.16 鹵0.15 cm ~ (-1) 鹵0.14 cm ~ (-1) ~ 0.91 鹵0.14 cm ~ (-1), respectively, and the diameter of the defect was 1.16 鹵0.15 cm ~ (-1) and 0.91 鹵0.14 cm ~ (-1) respectively. The external jugular approach was shorter than the femoral vein approach in operating time and X-ray exposure. Invasive pressure monitoring showed that there were significant differences in mean pulmonary artery pressure (MPAP), right ventricular pressure (RVP) and right atrial pressure (RAPP) between 3 months after operation (P < 0.01) and 3 months after operation (P < 0.01). The difference of right atrial diameter (RV), right ventricular diameter (RV) and left atrial diameter (LAA) was statistically significant (P < 0.01). Pathological examination 3 months after operation showed that scar tissue was formed, cardiac myocytes were arranged neatly, and no obvious degeneration was observed. Necrosis and proliferation of fibrous tissue, normal size of pulmonary arterioles, and no sign of muscularization. [conclusion]: transjugular interatrial septal puncture and balloon dilatation is an effective method for the establishment of porcine atrial septal defect (ASD) animal model. Simple, minimally invasive and repeatable method. The method of making porcine atrial septal defect animal model via external jugular vein was shorter in operation time and X-ray exposure time than that in femoral vein approach animal model of atrial septal defect. The animal model of porcine atrial septal deficiency mainly affects the hemodynamics and cardiac morphology of the right heart system. It is one of the methods to establish the left to right shunt pulmonary hypertension model.
【學(xué)位授予單位】：昆明醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R-332

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