本文選題：鼻腔填塞 + 止血材料��； 參考：《北京化工大學(xué)》2015年碩士論文

【摘要】：在我國有大量人群受到鼻炎、鼻息肉等鼻部問題的困擾,環(huán)境污染加劇,空氣狀況不佳等外界刺激更易使患者病況惡化,目前鼻內(nèi)鏡手術(shù)是解決鼻部疾病的有效手段。鼻內(nèi)鏡手術(shù)的成功與否與鼻腔填塞止血材料密切相關(guān),性能欠佳的鼻腔填塞止血材料容易導(dǎo)致填塞失敗,增加患者在填塞止血階段的痛苦,并有可能導(dǎo)致復(fù)雜的綜合并發(fā)癥。當(dāng)下國內(nèi)耳鼻喉科臨床實(shí)踐中使用的優(yōu)質(zhì)填塞止血材料多為國外產(chǎn)品,即使這些國外產(chǎn)品,也存在諸如生物親和性差、降解物對人體有害或不能在人體內(nèi)降解以及價格昂貴等多方面的問題,而國內(nèi)的鼻腔填塞止血材料性能普遍欠佳,因此開發(fā)性能良好的國產(chǎn)鼻腔填塞止血材料十分必要。羧甲基殼聚糖(CMCS)已被證明是具有良好醫(yī)藥應(yīng)用潛力的生物材料,但其泡沫材料存在較脆、易溶解以及易在人體內(nèi)殘留等問題。本文嘗試使用柔性高分子材料對CMCS進(jìn)行改性,特別是對其進(jìn)行增韌改性。文中選擇了聚乙二醇(PEG)和聚乙烯醇(PVOH)分別對CMCS進(jìn)行共混改性。(1)對實(shí)驗(yàn)中所有的原料CMCS進(jìn)行測定,主要測定選用的殼聚糖、羧甲基殼聚糖的水分、溶解性能、脫乙酰度、數(shù)均分子量等理化性質(zhì)。測定結(jié)果表明,所選用的CMCS的分子量為約為15萬;脫乙酰度約90%,；羧甲基殼聚糖的羧甲基度約為94%；原料殼聚糖以O(shè)-羧甲基殼聚糖為主。(2)嘗試使用PEG對CMCS進(jìn)行改性,對制備得到的PEG/CMCS復(fù)合材料進(jìn)行性能測試,測試結(jié)果表明該復(fù)合材料適用于普通鼻腔出血止血,不適用于ESS手術(shù)后。(3)嘗試用PVOH對CMCS進(jìn)行改性,以CMCS和PVOH為原料制備得到系列PVOH/CMCS海綿材料,并進(jìn)行了性能測試。測試結(jié)果表明,PVOH/CMCS海綿材料孔徑分布均勻,吸水率較高,并且隨著PVOH用量的增加,復(fù)合材料的吸水率也隨之增加,最高吸水率是材料自重的十倍；對這種復(fù)合材料力學(xué)性能的測定表明在引入PVOH后殼聚糖海綿材料韌性顯著提升,樣品的拉伸強(qiáng)度雖然有所下降,但實(shí)驗(yàn)樣品的斷裂伸長率能夠有顯著的提升,拉伸強(qiáng)度下降三分之一斷裂伸長率增加三倍左右,PVOH起到了增韌CMCS止血海綿的作用；PVOH的引入,對CMCS材料的降解時間影響不大,PVOH/CMCS復(fù)合材料的降解時間主要受到其中CMCS組分的影響。(4)合作單位用PVOH/CMCS復(fù)合材料實(shí)施了動物實(shí)驗(yàn),對生物相容性和止血效果等進(jìn)行了測定。實(shí)驗(yàn)結(jié)果表明,認(rèn)為這種材料安全無毒,生物相容性良好；該材料不適用于體內(nèi)填充止血；能夠在實(shí)驗(yàn)機(jī)體內(nèi)部分降解,降解產(chǎn)物無毒害,能夠被機(jī)體吸收；制備的PVOH/CMCS止血海綿填塞成功率較高,抽取十分方便；與納西棉止血海綿相比,本產(chǎn)品在填塞成功率、止血效果等方面占優(yōu)。
[Abstract]:In China, a large number of people are troubled by nasal problems such as rhinitis, nasal polyps, environmental pollution, poor air conditions and other external stimuli are more likely to make patients worse. At present, nasal endoscopic surgery is an effective means to solve nasal diseases. The success of endoscopic sinus surgery is closely related to the nasal packing and hemostatic materials. The poor performance of nasal packing and hemostatic materials can easily lead to the failure of packing, increase the pain of the patients at the stage of packing and hemostasis, and may lead to complex complications. At present, the high quality packing and hemostatic materials used in the clinical practice of otolaryngology in China are mostly foreign products. Even these foreign products have poor biological affinity. Degradation is harmful to human body or can not be degraded in human body, and the price is expensive. However, the performance of nasal packing hemostatic material is generally poor in China, so it is necessary to develop domestic nasal packing hemostatic material with good performance. Carboxymethyl chitosan (CMCS) has been proved to be a biomaterial with good potential for medical application, but its foam materials are brittle, soluble and easily residual in human body. In this paper, flexible polymer materials are used to modify CMCs, especially to toughen CMCs. In this paper, polyethylene glycol (PEG) and polyvinyl alcohol (PVOH) were used to modify CMCs respectively. All the raw materials CMCs were determined. The water content, solubility, deacetylation degree of chitosan and carboxymethyl chitosan were determined. Number average molecular weight and other physicochemical properties. The results show that the molecular weight of the selected CMCs is about 150000; the degree of deacetylation is about 90; the carboxymethyl chitosan is about 94; the raw material chitosan is mainly O- carboxymethyl chitosan. The properties of the prepared PEG / CMCS composite were tested. The results showed that the composite was suitable for hemostasis of common nasal cavity and not suitable for the treatment of ESS after operation.) PVOH was used to modify CMCS. A series of PVO / CMCS sponge materials were prepared from CMCs and PVOH, and their properties were tested. The results show that the pore size distribution of PVOH / CMCS sponge is uniform and the water absorption rate is high. With the increase of PVOH content, the water absorption rate of the composite also increases, and the maximum water absorption rate is 10 times of the weight of the material. The mechanical properties of the composite showed that the toughness of chitosan sponge increased significantly after the introduction of PVOH, and the tensile strength of the sample decreased, but the elongation at break of the experimental sample increased significantly. The decrease of tensile strength by 1/3 and the increase of elongation at break by about three times increased the effect of PVOH on toughening CMCs hemostatic sponge and the introduction of PVOH. The degradation time of PVOH / CMCS composite was mainly affected by the CMCS component. The co-workers carried out animal experiments with PVOH / CMCS composite, and the biocompatibility and hemostatic effect were measured. The experimental results show that the material is safe and non-toxic and has good biocompatibility, which is not suitable for filling and hemostasis in vivo, and can be partially degraded in the experimental organism, and the degradation product is non-toxic and can be absorbed by the body. Compared with Naxi cotton hemostatic sponge, the success rate and hemostatic effect of PVOH / CMCS were better than that of Naxi cotton hemostatic sponge.
【學(xué)位授予單位】：北京化工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R318.08

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