本文關(guān)鍵詞：維拉帕米—硝酸甘油保存液對(duì)兔靜脈的保護(hù)作用　出處：《河北醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 冠狀動(dòng)脈旁路移植術(shù) 靜脈保存液 維拉帕米-硝酸甘油混合液 內(nèi)皮素 內(nèi)皮細(xì)胞覆蓋率 再狹窄

【摘要】：目的:冠心病從20世紀(jì)初開(kāi)始在工業(yè)化國(guó)家流行,至今仍是當(dāng)今社會(huì)發(fā)達(dá)國(guó)家以及發(fā)展中國(guó)家普通人群發(fā)病率和死亡率的主要原因之一,是危害人類健康的“第一殺手”。為此,人類對(duì)于冠心病治療方法的研究也從未止步。1962年Sabiston進(jìn)行了世界上首例冠狀動(dòng)脈旁路移植術(shù)(CABG),距今已有半個(gè)世紀(jì)的歷史。盡管當(dāng)今介入療法深受追捧,但冠脈旁路移植術(shù)在冠心病的治療中仍然享有不可替代的地位。大隱靜脈(GSV)因其便于取材、長(zhǎng)度足夠、對(duì)人體影響較小而成為CABG中最主要的血管移植材料。但是大隱靜脈橋術(shù)后15年通暢率只有50%,這極大的影響了冠心病人術(shù)后生活質(zhì)量及生命安全。基于臨床實(shí)踐經(jīng)驗(yàn),從大隱靜脈離體到搭完最后一根橋(通常1個(gè)病人需要搭3-4根橋),靜脈至少需要處于離體狀態(tài)30-60分鐘,而這一段時(shí)間的靜脈保護(hù)就只能依靠適當(dāng)?shù)谋４嬉�。研究發(fā)現(xiàn)這一環(huán)節(jié)的保護(hù)是否有效對(duì)于CABG的近期及遠(yuǎn)期通暢率有著重要的影響。GV液是維拉帕米和硝酸甘油的混合溶液,1993年Guo-Wei He等將這兩種藥物共同用于大隱靜脈的保護(hù),取得了不錯(cuò)的效果。近年來(lái)大量的研究顯示了GV液的功效,同時(shí)它簡(jiǎn)單易配,價(jià)格低廉,可能是一種很理想的靜脈保護(hù)液。本實(shí)驗(yàn)設(shè)計(jì)以兔頸外靜脈倒置端側(cè)吻合于同側(cè)頸動(dòng)脈為動(dòng)物模型,旨在研究GV液對(duì)靜脈的近期及遠(yuǎn)期保護(hù)作用,作為進(jìn)一步研究的參考,為GV液用于臨床提供實(shí)驗(yàn)依據(jù)。方法:成年新西蘭大耳兔30只,雌雄不限,體重在2.5-3.0kg之間。隨機(jī)分為3組,分別為A.空白對(duì)照組,B.罌粟堿生理鹽水對(duì)照組,C.GV液實(shí)驗(yàn)組。取下一側(cè)頸外靜脈,室溫下于對(duì)應(yīng)的保存液中保存30分鐘,然后將靜脈分為兩段,一段用于形態(tài)學(xué)觀察(HE染色后計(jì)算內(nèi)皮細(xì)胞覆蓋率和透射電鏡下觀察內(nèi)膜保護(hù)情況),另一段上下倒置吻合于同側(cè)頸動(dòng)脈上。收集保存過(guò)標(biāo)本的保存液以Elisa法測(cè)ET-1含量。2周后取下橋血管,做HE染色觀察內(nèi)膜增厚情況,計(jì)算內(nèi)膜比中膜厚度比值即I/M。所得數(shù)據(jù)以SPSS13.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析。計(jì)量數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差描述,各組數(shù)據(jù)分別進(jìn)行正態(tài)性檢驗(yàn)和方差齊性檢驗(yàn)。如果數(shù)據(jù)符合正態(tài)方差齊的條件,就可以使用完全隨機(jī)設(shè)計(jì)兩均數(shù)比較的t檢驗(yàn)來(lái)分別檢驗(yàn)兩組均數(shù)有無(wú)差異。若正態(tài)但方差不齊,可以用對(duì)自由度進(jìn)行校正后的t′檢驗(yàn)比較兩組均數(shù)差異。如果非正態(tài)方差不齊,使用非參數(shù)檢驗(yàn)。以P0.05為標(biāo)準(zhǔn),認(rèn)為差別具有統(tǒng)計(jì)學(xué)意義。結(jié)果:在近期保護(hù)實(shí)驗(yàn)中,空白組內(nèi)皮細(xì)胞覆蓋率得分1.556±0.416,對(duì)照組1.850±0.264,實(shí)驗(yàn)組2.550±0.430。GV液組內(nèi)皮細(xì)胞覆蓋率明顯高于前兩組,差別有統(tǒng)計(jì)學(xué)意義(P0.05),而罌粟堿生理鹽水對(duì)內(nèi)皮破壞較大,與空白組差異不大,差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。從電鏡下可見(jiàn)實(shí)驗(yàn)組內(nèi)皮細(xì)胞與基膜連接較完整,胞間連接緊密,細(xì)胞器功能保存較好。而罌粟堿組及空白組內(nèi)皮細(xì)胞脫落嚴(yán)重,胞質(zhì)水腫,細(xì)胞間緊密連接打開(kāi),線粒體空泡化,嵴融合。Elisa的結(jié)果:A組:152.172±14.427 ng/L,B組:144.880±10.149 ng/L,C組:61.032±10.849 ng/L,GV液中ET-1釋放量明顯低于空白組及對(duì)照組,差別有統(tǒng)計(jì)學(xué)意義(P0.05)。2周后測(cè)量橋血管I/M值,A組:1.469±0.159,B組:1.478±0.160,C組:0.539±0.123,GV液組內(nèi)膜增厚最輕,與其他兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:在兔靜脈保護(hù)實(shí)驗(yàn)中,GV液在保護(hù)內(nèi)膜、抑制內(nèi)皮素及抑制血管橋再狹窄方面均優(yōu)于罌粟堿生理鹽水和肝素鹽水。罌粟堿生理鹽水與肝素生理鹽水在內(nèi)膜保護(hù)、抑制內(nèi)皮素釋放、預(yù)防狹窄方面沒(méi)有明顯差異。
[Abstract]:Objective: coronary heart disease from the beginning of twentieth Century in the industrialized countries, is still in today's society in the developed countries and the main cause of morbidity and mortality in developing countries is one of the common people, harm to human health "the first killer". Therefore, human studies for coronary heart disease treatment has never stopped.1962 Sabiston performed the first coronary artery bypass grafting (CABG), which has a history of half a century. Despite the intervention sought after, but coronary artery bypass grafting in the treatment of coronary heart disease still enjoys irreplaceable position. The great saphenous vein (GSV) materials, because of its easy enough length, less effect to human body and has become the most important vessel graft material in CABG. But the great saphenous vein after 15 year patency rate was only 50%, which has a great influence on patients with coronary heart disease postoperative quality of life and life safety based on. Clinical experience, from the great saphenous vein in vitro to take the last one bridge (usually 1 patients need a 3-4 root bridge), at least in vitro vein and vein protection for 30-60 minutes, this time can only rely on the appropriate preservation solution. The study found that the protection of this link is valid for CABG of the short-term and long-term patency rate has important effect of.GV liquid is a mixture of Vera Pammy and nitroglycerin, 1993 Guo-Wei He of the two kinds of common drugs for the protection of great saphenous vein, and achieved good results. In recent years a large number of studies show that the GV effect of fluid, and it is easy to match the price. Low, may be an ideal intravenous protection liquid. The experimental design to the external jugular vein inverted end to side anastomosis in the ipsilateral carotid artery as the animal model to study GV solution on the vein of the short-term and long-term protective effect, as in a Step on the reference, to provide experimental basis for clinical GV solution for adult. Methods: 30 New Zealand rabbits, male or female, weighing between 2.5-3.0kg were randomly divided into 3 groups, respectively A. blank control group, B. papaverine saline control group, experimental group C.GV solution. Remove the external jugular vein at room temperature, preservation solution corresponding to the stored in 30 minutes, and then the vein is divided into two sections, one section for morphological observation (HE staining after calculation of endothelial cell coverage and transmission electron microscope observation of endometrial protection), the other section of the inverted anastomosis in the ipsilateral carotid artery. Save to save fluid specimens under the bridge were taken using Elisa method to measure the content of ET-1 after.2 weeks, HE staining was used to observe the intimal thickening, the intimal medial thickness ratio than that of the I/M. data with SPSS13.0 statistical software for statistical analysis. Measurement data with the standard deviation of each data description. Are test of normality and homogeneity of variance test. If the data accord with normal variance conditions, you can use a completely randomized design two average t test compared to test two groups have no difference. But if the normal variance not neat, can be used for inspection after correction of T 'the degrees of freedom were compared between the two groups. If the non normal variance not neat, using non parametric test. Based on the standard of P0.05, was considered statistically significant. Results: in the near future protection experiment, blank group endothelial cell coverage score 1.556 + 0.416, 1.850 + 0.264 in the control group, the experimental group was 2.550 + 0.430.GV group of endothelial cell coverage rate was significantly higher than that of the former two groups, the difference was statistically significant (P0.05), and papaverine saline on endothelial damage, with little difference in blank group, no significant difference (P0.05). From the experimental group under electron microscope in skin cells and medium The film is connected with complete intercellular tight junction, cell function is well preserved. The papaverine group and blank group endothelial cell loss serious, cytoplasmic edema, intercellular tight junctions on mitochondrial vacuolization, cristae fusion.Elisa results: A group: 152.172 + 14.427 ng/L, group B: 144.880 + 10.149 ng/L, C group: 61.032 + 10.849 ng/L, GV was the release of ET-1 was significantly lower than the blank group and the control group, the difference was statistically significant (P0.05).2 weeks after the measurement of vascular bridge I/M, A group: 1.469 + 0.159, 1.478 + 0.160, B group: C group: 0.539 + 0.123 GV, liquid membrane thickening group the light, and there was significant difference between two groups (P0.05). Conclusion: in the experimental rabbit vein protection, GV protection fluid in the intima, inhibition of endothelin and inhibition of restenosis were better than papaverine saline and heparin saline. Papaverine saline and heparin saline in endometrial protection, inhibit There was no significant difference between the release of skin hormone and the prevention of stenosis.

【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】：2015
【分類號(hào)】：R543.6

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