羊膜防治心包缺損致粘連的作用研究
發(fā)布時間：2018-10-19 11:48
【摘要】：目的:為心胸外科二次手術創(chuàng)造較好的局部手術環(huán)境,本研究在模擬開胸術基礎上探討新鮮人羊膜(human amniotic membrane,HAM)對兔心包缺損后修復心包膜的效果及對心臟與周圍組織粘連的影響。方法:健康新西蘭大白兔54只隨機分為對照組、模型組(心包缺損)和HAM組(HAM修復缺損心包),其中對照組18只僅行開胸手術,心包不做其他處理;模型組18只行開胸術后造心包缺損模型后擦心外膜,HAM組18只行開胸術后造心包缺損模型后擦心外膜并采用新鮮雙層HAM修復心包膜,操作完畢后均常規(guī)關閉胸腔,留置胸腔引流管。術后30、60和180天分別進行心功能檢測、心臟粘連和纖維化程度的宏觀和微觀評價及心肌組織病理學檢查。結果:(1)培養(yǎng)HAM后的培養(yǎng)基上清液中表達白細胞介素-10(Interleukin-10,IL-10),高表達基質金屬蛋白酶-9(matrix metalloproteinase-9,MMP-9),不表達轉化生長因子-β3(Transforming grow factor-β3,TGF-β3)。(2)術后觀察180天,對照組和HAM組無動物死亡,模型組動物死亡率為15%,各組之間比較差異無統(tǒng)計學意義(P0.05)。(3)第30天,三組動物心功能指標LVSP、LVEDP、HR、+Max d P/dt和-Min d P/dt之間比較,差異無統(tǒng)計學意義(P0.05);第60天,對照組和HAM組的+Max d P/dt明顯高于模型組(P0.05);第180天,對照組、HAM組和模型組+Max d P/dt值分別為4684.61±452.03、4784.30±373.61和3044.69±379.90,-Min d P/dt值則為-3161.58±739.91、-3437.87±421.84和-2278.57±325.89,對照組和HAM組+Max d P/dt值和-Min d P/dt值均高于模型組(P0.05),其余四項心功能指標三組之間比較,差異無統(tǒng)計學意義(P0.05)。(4)第30天,對照組無明顯粘連發(fā)生,HAM組和模型組的宏觀粘連評分均為輕度,兩組之間比較差異無統(tǒng)計學意義(P0.05);第60天,HAM組宏觀粘連評分值為1.33±0.52,明顯低于模型組中度粘連的值2.5±0.55(P0.05);第180天,對照組、模型組和HAM組宏觀粘連評分值分別為0、2.4±0.55和1.17±0.41,即模型組宏觀粘連評分值明顯高于HAM組(P0.05)。(5)HE染色后,顯微鏡下可見,模型組心肌與周圍組織粘連隨觀察時間延長,呈進行性加重趨勢,粘連纖維化分級1-2,炎癥分級0-2,而HAM組心肌與周圍組織粘連180天時明顯減輕,粘連纖維化分級0-1,炎癥分級0-1,粘連極易分離,HAM已大部分被吸收,三組心肌細胞損傷均不明顯。結論:(1)HAM的分泌物中表達IL-10,高表達MMP-9,不表達TGF-β3。(2)直接剪除心包膜+摩擦心室壁和空氣暴露所致的心包缺損模型,60天至180天出現(xiàn)明顯的心臟與周圍組織的輕中度粘連,且心功能呈進行性的心室收縮性能與舒張性能的下降。(3)發(fā)現(xiàn)HAM修補心包膜缺損的新西蘭兔模型具有明顯的防治心臟與周圍組織器官粘連的良好療效,并有利于保持心臟功能正常,其防粘連作用可能與HAM分泌IL-10和MMP-9有關。
[Abstract]:Objective: to create a better local operation environment for the secondary operation of cardiothoracic surgery. The purpose of this study was to investigate the effect of fresh human amniotic membrane (human amniotic membrane,HAM) on the repair of pericardial membrane after pericardial defect in rabbits and its effect on the adhesion between heart and surrounding tissues on the basis of simulated thoracotomy. Methods: 54 healthy New Zealand white rabbits were randomly divided into two groups: model group (pericardial defect) and HAM group (HAM repair of defect pericardium). The pericardial defect model was made after thoracotomy in 18 rats in the model group and the pericardial defect model in the HAM group in 18 cases. The pericardium was repaired with fresh double-layer HAM after thoracotomy. The pleural cavity was routinely closed after operation. Indwelling thoracic drainage tube. Cardiac function, macroscopical and microscopic evaluation of the degree of cardiac adhesion and fibrosis and myocardial histopathological examination were performed at 30 days and 180 days after operation respectively. Results: (1) Interleukin-10 (Interleukin-10,IL-10), matrix metalloproteinase-9 (matrix metalloproteinase-9,MMP-9), transforming growth factor- 尾 3 (Transforming grow factor- 尾 3- TGF- 尾 3). (2 were expressed in the supernatant of culture medium after HAM culture. The mortality rate of the model group was 15. There was no significant difference between the three groups (P0.05). (3) on the 30th day. There was no significant difference between the three groups of cardiac function indexes LVSP,LVEDP,HR, Max d P/dt and-Min d P/dt (P0.05); on the 60th day, there was no significant difference between the three groups. The Max d P/dt in the control group and HAM group was significantly higher than that in the model group (P0.05). The values of Max d P/dt in control group, HAM group and model group were 4684.61 鹵452.03t 4784.30 鹵373.61 and 3044.69 鹵379.90 Min d P/dt, respectively, which were -3161.58 鹵739.91 -3437.87 鹵421.84 and -2278.57 鹵325.89, respectively. The Max d P/dt and-Min d P/dt in control group and HAM group were higher than those in model group (P0.05). There was no significant difference between the two groups (P0.05). (4) on the 30th day, there was no significant adhesion in the control group, and the macroscopic adhesion score in the HAM group and the model group was mild. There was no significant difference between the two groups (P0.05); on the 60th day, the macroscopic adhesion score of the HAM group was 1.33 鹵0.52, which was significantly lower than that of the model group (2.5 鹵0.55, P0.05). The macroscopic adhesion scores of model group and HAM group were 0.2.4 鹵0.55 and 1.17 鹵0.41, respectively. That is, the macroscopic adhesion score of model group was significantly higher than that of HAM group (P0.05). (5) HE staining. The adhesion fibrosis grade was 1-2, the inflammation grade was 0-2, and the adhesion fibrosis grade was 0-1, the inflammation grade was 0-1, the adhesive fibrosis grade was 0-1, the adhesion grade was easy to separate, the HAM was absorbed mostly, and the myocardial cell injury was not obvious in the HAM group. Conclusion: (1) the high expression of IL-10, in the secretion of HAM does not express TGF- 尾 3. (2) the pericardial defect model caused by pericardial frictional wall and air exposure was cut off directly. From 60 to 180 days, obvious adhesion between the heart and surrounding tissues was observed. Furthermore, the ventricular systolic and diastolic properties of the rabbits with progressive cardiac function were decreased. (3) it was found that HAM repair of pericardial defects in New Zealand rabbits had a good effect on preventing and treating adhesion between heart and surrounding tissues and organs. It may be related to the secretion of IL-10 and MMP-9 by HAM.
【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654
本文編號：2281026
[Abstract]:Objective: to create a better local operation environment for the secondary operation of cardiothoracic surgery. The purpose of this study was to investigate the effect of fresh human amniotic membrane (human amniotic membrane,HAM) on the repair of pericardial membrane after pericardial defect in rabbits and its effect on the adhesion between heart and surrounding tissues on the basis of simulated thoracotomy. Methods: 54 healthy New Zealand white rabbits were randomly divided into two groups: model group (pericardial defect) and HAM group (HAM repair of defect pericardium). The pericardial defect model was made after thoracotomy in 18 rats in the model group and the pericardial defect model in the HAM group in 18 cases. The pericardium was repaired with fresh double-layer HAM after thoracotomy. The pleural cavity was routinely closed after operation. Indwelling thoracic drainage tube. Cardiac function, macroscopical and microscopic evaluation of the degree of cardiac adhesion and fibrosis and myocardial histopathological examination were performed at 30 days and 180 days after operation respectively. Results: (1) Interleukin-10 (Interleukin-10,IL-10), matrix metalloproteinase-9 (matrix metalloproteinase-9,MMP-9), transforming growth factor- 尾 3 (Transforming grow factor- 尾 3- TGF- 尾 3). (2 were expressed in the supernatant of culture medium after HAM culture. The mortality rate of the model group was 15. There was no significant difference between the three groups (P0.05). (3) on the 30th day. There was no significant difference between the three groups of cardiac function indexes LVSP,LVEDP,HR, Max d P/dt and-Min d P/dt (P0.05); on the 60th day, there was no significant difference between the three groups. The Max d P/dt in the control group and HAM group was significantly higher than that in the model group (P0.05). The values of Max d P/dt in control group, HAM group and model group were 4684.61 鹵452.03t 4784.30 鹵373.61 and 3044.69 鹵379.90 Min d P/dt, respectively, which were -3161.58 鹵739.91 -3437.87 鹵421.84 and -2278.57 鹵325.89, respectively. The Max d P/dt and-Min d P/dt in control group and HAM group were higher than those in model group (P0.05). There was no significant difference between the two groups (P0.05). (4) on the 30th day, there was no significant adhesion in the control group, and the macroscopic adhesion score in the HAM group and the model group was mild. There was no significant difference between the two groups (P0.05); on the 60th day, the macroscopic adhesion score of the HAM group was 1.33 鹵0.52, which was significantly lower than that of the model group (2.5 鹵0.55, P0.05). The macroscopic adhesion scores of model group and HAM group were 0.2.4 鹵0.55 and 1.17 鹵0.41, respectively. That is, the macroscopic adhesion score of model group was significantly higher than that of HAM group (P0.05). (5) HE staining. The adhesion fibrosis grade was 1-2, the inflammation grade was 0-2, and the adhesion fibrosis grade was 0-1, the inflammation grade was 0-1, the adhesive fibrosis grade was 0-1, the adhesion grade was easy to separate, the HAM was absorbed mostly, and the myocardial cell injury was not obvious in the HAM group. Conclusion: (1) the high expression of IL-10, in the secretion of HAM does not express TGF- 尾 3. (2) the pericardial defect model caused by pericardial frictional wall and air exposure was cut off directly. From 60 to 180 days, obvious adhesion between the heart and surrounding tissues was observed. Furthermore, the ventricular systolic and diastolic properties of the rabbits with progressive cardiac function were decreased. (3) it was found that HAM repair of pericardial defects in New Zealand rabbits had a good effect on preventing and treating adhesion between heart and surrounding tissues and organs. It may be related to the secretion of IL-10 and MMP-9 by HAM.
【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654
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