本文選題：冠狀動(dòng)脈旁路移植術(shù)　切入點(diǎn)：尼卡地平注射液　出處：《河北醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:冠狀動(dòng)脈旁路移植術(shù)是如今治療冠心病的最可靠的手段之一,現(xiàn)階段主要的靜脈橋血管來源是大隱靜脈,但是大隱靜脈血管橋的十年通暢率遠(yuǎn)低于動(dòng)脈橋,僅有50%-70%左右,因此,提高大隱靜脈血管橋的通暢率至關(guān)重要。在手術(shù)過程中,大隱靜脈的體外保存是冠狀動(dòng)脈旁路移植術(shù)的重要環(huán)節(jié),也是影響術(shù)后近遠(yuǎn)期通暢率的重要方面,如果能為臨床工作提供一種對(duì)靜脈橋血管內(nèi)皮細(xì)胞損害小,對(duì)血管的舒張作用好的保存液,必將極大提高冠狀動(dòng)脈旁路移植術(shù)的靜脈橋血管近遠(yuǎn)期通暢率,促進(jìn)搭橋手術(shù)進(jìn)一步發(fā)展。尼卡地平注射液為二氫吡啶類Ca~(2+)通道阻滯劑,屬于第二代鈣拮抗藥,它有抑制Ca~(2+)內(nèi)流的作用,從而抑制cAMP磷酸二酯酶導(dǎo)致細(xì)胞cAMP不斷上升,有強(qiáng)烈的擴(kuò)張血管的作用,尤其對(duì)冠狀動(dòng)脈血管和腦血管作用明顯。其性質(zhì)穩(wěn)定,療效確切。本實(shí)驗(yàn)研究尼卡地平注射液對(duì)兔靜脈血管的保護(hù)作用,與臨床常用的罌粟堿做對(duì)比,為其作為冠脈搭橋術(shù)中靜脈移植物的保存液用于臨床提供理論依據(jù)。方法:1首先將家兔進(jìn)行分組,將30只家兔隨機(jī)分為三組,每組10只,空白組:肝素及生理鹽水;對(duì)照組:肝素、罌粟堿及生理鹽水;實(shí)驗(yàn)組:肝素、尼卡地平注射液及生理鹽水。然后建立動(dòng)物模型,取家兔頸外靜脈4-5cm,將從各組家兔取下的頸外靜脈放入相應(yīng)保護(hù)液中浸泡30分鐘,將取下的頸外靜脈分為A、B兩段,A段用于電鏡及近期光鏡檢查,進(jìn)行對(duì)比。B段用于與頸總動(dòng)脈吻合,吻合完成后繼續(xù)飼養(yǎng),1個(gè)月后截取橋血管中間部,進(jìn)行遠(yuǎn)期光鏡檢查。并應(yīng)用ELISA法測(cè)定各保存液TXA2含量。2所得數(shù)據(jù)使用統(tǒng)計(jì)軟件SPSS13.0進(jìn)行統(tǒng)計(jì)數(shù)據(jù)分析。各組所得數(shù)據(jù)均進(jìn)行正態(tài)性檢驗(yàn)以及方差齊性檢驗(yàn)。如果數(shù)據(jù)符合正態(tài)分布,且方差齊,即使用成組t檢驗(yàn)來分析兩組均數(shù)有無差異及差異的統(tǒng)計(jì)學(xué)意義。若符合正態(tài)但方差不齊,即用校正自由度后的t’檢驗(yàn)比較兩組均數(shù)有無差異及差異的統(tǒng)計(jì)學(xué)意義。若非正態(tài)且方差不齊,則使用非參數(shù)檢驗(yàn)。若p0.05,則認(rèn)為存在的差別具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1實(shí)驗(yàn)近期研究指標(biāo):1)通過光學(xué)顯微鏡檢查顯示血管內(nèi)皮細(xì)胞覆蓋率得分分別為:空白組1.775±0.321分,對(duì)照組1.750±0.353分,實(shí)驗(yàn)組2.150±0.428分。三組數(shù)據(jù)首先進(jìn)行正態(tài)性檢驗(yàn),均符合正態(tài)性分布再相互進(jìn)行方差齊性檢驗(yàn)及t檢驗(yàn),其結(jié)果為:對(duì)照組與空白組差異無統(tǒng)計(jì)學(xué)意義(p0.05),實(shí)驗(yàn)組與對(duì)照組差異有統(tǒng)計(jì)學(xué)意義(p0.05),實(shí)驗(yàn)組與空白組差異有統(tǒng)計(jì)學(xué)意義(p0.05)。實(shí)驗(yàn)結(jié)果表明近期光鏡檢測(cè)下,尼卡地平組血管內(nèi)皮覆蓋率高于罌粟堿組及肝素組,且有統(tǒng)計(jì)學(xué)意義,罌粟堿組血管內(nèi)皮覆蓋率與肝素組無統(tǒng)計(jì)學(xué)差異。2)通過電子顯微鏡檢查顯示實(shí)驗(yàn)組:部分標(biāo)本可見內(nèi)皮細(xì)胞少量脫落,視野下內(nèi)皮細(xì)胞少見空泡及水腫,內(nèi)皮細(xì)胞形態(tài)大多完整,細(xì)胞器少見異常,基底膜連續(xù)性好且與周圍細(xì)胞連接緊密。對(duì)照組:標(biāo)本多見內(nèi)皮細(xì)胞脫落,視野下部分內(nèi)皮細(xì)胞可見水腫,內(nèi)皮細(xì)胞形態(tài)基本完整,基底膜連續(xù)性差或不連續(xù),與周圍細(xì)胞連接欠緊密�？瞻捉M:血管內(nèi)皮細(xì)胞結(jié)構(gòu)破壞嚴(yán)重,部分標(biāo)本看不到完整內(nèi)皮細(xì)胞,無連續(xù)性基底膜。3)各組保存液TXA2含量elisa檢測(cè)法檢測(cè)結(jié)果:TXA2含量實(shí)驗(yàn)組:48.434±12.161pg/ml,對(duì)照組:60.207±10.346pg/ml,空白組:60.457±12.272pg/ml。三組數(shù)據(jù)首先進(jìn)行正態(tài)性檢驗(yàn),均符合正態(tài)性分布再相互進(jìn)行方差齊性檢驗(yàn)及t檢驗(yàn)結(jié)果為:對(duì)照組與空白組差異無統(tǒng)計(jì)學(xué)意義(p0.05),實(shí)驗(yàn)組與對(duì)照組差異有統(tǒng)計(jì)學(xué)意義(p0.05),實(shí)驗(yàn)組與空白組差異有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)果表明尼卡地平組TXA2含量低于罌粟堿組及肝素組,且有統(tǒng)計(jì)學(xué)意義,罌粟堿組TXA2含量與肝素組無統(tǒng)計(jì)學(xué)差異。2實(shí)驗(yàn)遠(yuǎn)期研究指標(biāo):通過光學(xué)顯微鏡檢查顯示血管內(nèi)皮細(xì)胞覆蓋率得分分別為:空白組1.550±0.197分,對(duì)照組1.600±0.316分,實(shí)驗(yàn)組1.975±0.321分。三組數(shù)據(jù)首先進(jìn)行正態(tài)性檢驗(yàn),均符合正態(tài)性分布再相互進(jìn)行方差齊性檢驗(yàn)及t檢驗(yàn)結(jié)果為:對(duì)照組與空白組差異無統(tǒng)計(jì)學(xué)意義(p0.05),實(shí)驗(yàn)組與對(duì)照組差異有統(tǒng)計(jì)學(xué)意義(p0.05),實(shí)驗(yàn)組與空白組差異有統(tǒng)計(jì)學(xué)意義(p0.05)。實(shí)驗(yàn)結(jié)果表明遠(yuǎn)期光鏡檢測(cè)下,尼卡地平組血管內(nèi)皮覆蓋率高于罌粟堿組及肝素組,且有統(tǒng)計(jì)學(xué)意義,罌粟堿組血管內(nèi)皮覆蓋率與肝素組無統(tǒng)計(jì)學(xué)差異。結(jié)論:1尼卡地平注射液比罌粟堿對(duì)兔靜脈血管內(nèi)皮細(xì)胞的有更好的保護(hù)作用。主要表現(xiàn)在對(duì)內(nèi)皮細(xì)胞形態(tài)的保護(hù)及內(nèi)皮細(xì)胞的覆蓋率。2尼卡地平保存液保存的血管比罌粟堿保存液保存的血管產(chǎn)生的血栓素A2少。
[Abstract]:Objective: coronary artery bypass grafting is one of the most reliable means now in the treatment of coronary heart disease, the main source of vein grafts at this stage is of great saphenous vein, but the ten year patency rate of great saphenous vein artery is far below the bridge, only about 50%-70%, therefore, improve the patency rate of the saphenous vein during operation is very important. In the process of the great saphenous vein in vitro preservation is an important link of coronary artery bypass grafting, but also affect the postoperative patency as well as an important aspect of, if can provide a kind of vein graft vascular endothelial cells injury for clinical work, the vasorelaxing effect of the preservation solution, will greatly improve the long-term patency rate of nearly the vein grafts of coronary artery bypass grafting, and promote the further development of bypass surgery. Nicardipine injection for two dihydropyridine Ca~ (2+) channel blocker, which belongs to the second generation of calcium antagonists It has, the inhibition of Ca~ (2+) in the flow, thereby inhibiting phosphodiesterase cAMP induced cAMP rise, expansion of blood vessels strong role, especially on coronary artery and cerebrovascular function obviously. Its stability, curative effect. The experimental study on protective effect of nicardipine injection on rabbit vein and compared with the clinical commonly used papaverine, to provide the theory basis for the clinical as preservation of vein grafts in coronary artery bypass grafting. Methods: 1 rabbits were first grouped, 30 rabbits were randomly divided into three groups, 10 rats in each group: blank group, saline control group and heparin; heparin. Papaverine and saline; experimental group: heparin, nicardipine injection and normal saline. Then on the establishment of animal models, the rabbit jugular vein 4-5cm from rabbits in each group were taken from the jugular vein into the corresponding protective liquid for 30 minutes, will Remove the external jugular vein was divided into A, B two, A section for electron microscopy and light microscopy in comparison to.B, consistent with the common carotid artery, anastomosis after feeding, 1 months after the interception of vascular bridge in middle part of the forward light microscopic examination and determination of TXA2 content. The data of the.2 preservation solution for statistical data analysis using statistical software SPSS13.0 using ELISA method. The data was evaluated using the test of normality and homogeneity of variance test. If the data to conform to normal distribution, and variance, namely the use of group t test to analyze the two groups have no significant difference and difference. If the line is but the state variance not neat, with degrees of freedom correction after t test between two groups had no statistically significant difference and difference. If the normality and homogeneity of variance, non parametric test. If P0.05, believes that the difference has statistical significance. Results: 1 Experimental Study: 1) the recent index by optical microscope showed that vascular endothelial cell coverage score respectively: blank group 1.775 + 0.321, 1.750 + 0.353 in control group, experimental group 2.150 + 0.428 points. The first three sets of data normality test, accord with the normal distribution to each other homogeneity of variance test and t test, the results are as follows: the differences between the two groups and the control group had no statistical significance (P0.05), the experimental group and the control group was statistically significant (P0.05), there was statistically significant difference between the experimental group and the control group (P0.05). The experimental results show that the light microscope detection, nicardipine group blood vessels endothelial coverage rate is higher than the papaverine group and heparin group, and there was statistical significance, papaverine group vascular endothelial coverage and the heparin group showed no significant difference.2) showed that the experimental group by electron microscopy: endothelial cells were seen as a little off, Wild endothelial cells under rare vacuoles and edema, endothelial cells are mostly intact organelles, rare anomalies, basement membrane continuity and closely connected with the surrounding cells. Control group: specimens of rare endothelial cell loss, from the perspective of some endothelial cells edema, endothelial cells form the basic integrity of basement membrane, poor continuity or not continuously, with the surrounding cells connected closely. In the blank group: the structure of vascular endothelial cells were severely damaged, can not see the complete discontinuity of endothelial cells, basement membrane.3) were stored testing results of TXA2 content of the liquid ELISA method: the content of TXA2 in experimental group: 48.434 + 12.161pg/ml, 60.207 + 10.346pg/ml, the control group: blank group 12.272pg/ml.: 60.457 + three group data first normality test, accord with the normal distribution and mutual homogeneity of variance test and t test results: differences in control group and blank group had no statistical significance (P 0.05), the experimental group and the control group was statistically significant (P0.05), there was statistically significant difference between the experimental group and the control group (P0.05). The results showed that nicardipine group TXA2 was lower than that of papaverine group and heparin group, and there was statistical significance, TXA2 content of papaverine group and heparin group showed no significant difference.2 test index: long-term research through the optical microscope showed that vascular endothelial cell coverage score respectively: blank group 1.550 + 0.197, 1.600 + 0.316 in control group, experimental group 1.975 + 0.321 points. The first three sets of data normality test, accord with the normal distribution of each other by homogeneity test of variance and t test results: differences in control group and blank group had no statistical significance (P0.05), the experimental group and the control group was statistically significant (P0.05), there was statistically significant difference between the experimental group and the control group (P0.05). The experimental results show that the forward light detection, Nicardipine group vascular endothelial coverage rate is higher than the papaverine group and heparin group, and there was statistical significance, papaverine group vascular endothelial coverage and the heparin group showed no significant difference. Conclusion: 1 nicardipine injection protection than papaverine on rabbit vein endothelial cells have better effect. Mainly in the protection of endothelial cell morphology and endothelial cell coverage.2 nicardipine solution in preservation of the vascular preservation of thromboxane A2 less saved than papaverine.

【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】：2016
【分類號(hào)】：R654.2

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