本文關(guān)鍵詞：生肌通竅止血海綿止血作用的實(shí)驗(yàn)研究及臨床療效觀察　出處：《安徽中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 生肌通竅止血海綿 CRS 止血 組織相容性 術(shù)腔黏膜修復(fù)

【摘要】：目的:(1)驗(yàn)證生肌通竅止血海綿對(duì)鼻內(nèi)鏡手術(shù)術(shù)后術(shù)腔止血及促進(jìn)術(shù)腔黏膜修復(fù)作用;(2)探討生肌通竅止血海綿止血及術(shù)腔黏膜修復(fù)的可能機(jī)制;(3)求證中醫(yī)藥在鼻竇炎鼻內(nèi)鏡術(shù)后術(shù)腔止血以及促進(jìn)黏膜修復(fù)中應(yīng)用的可能性。方法:(1)取30只家兔入組,隨機(jī)分為正常對(duì)照組、對(duì)照組I和治療組I,分別在家兔背部?jī)蓚?cè)對(duì)稱處做切口,切斷筋膜上血管,待血液自然流出后開始計(jì)時(shí),正常對(duì)照組不予以干預(yù)、治療組I和對(duì)照組I分別立即將生肌通竅止血海綿、膨脹海綿分別置于切口出血處,每隔15s用濾紙吸去血滴1次,直至血液自然停止,整個(gè)過(guò)程用攝像儀記錄出血情況,并運(yùn)用視頻分析軟件計(jì)算出血時(shí)間;(2)取20只家兔入組,隨機(jī)分為治療組II和對(duì)照組II,分別在家兔背部?jī)蓚?cè)對(duì)稱處做切口,分別將生肌通竅止血海綿、膨脹海綿置于兩組家兔背部切口內(nèi),縫合切口,48小時(shí)后打開切口,取出填塞物,觀察切口內(nèi)情況,并取填塞物周圍組織行HE染色檢測(cè);(3)取20只家兔入組,隨機(jī)分為治療組III和對(duì)照組III,分別從鼻背切口打開家兔鼻竇,分別將生肌通竅止血海綿、膨脹海綿置于鼻竇內(nèi),縫合切口,48小時(shí)后打開切口,取出填塞物,觀察竇內(nèi)情況,并取竇腔黏膜行HE染色檢測(cè);(4)符合診斷標(biāo)準(zhǔn)并具手術(shù)指征的60例慢性鼻-鼻竇炎病例選擇入組,隨機(jī)劃分為治療組IV和對(duì)照組IV,兩組均常規(guī)行鼻內(nèi)鏡鼻竇開放術(shù),治療組IV和對(duì)照組IV術(shù)后術(shù)腔分別予以生肌通竅止血海綿和膨脹海綿填塞,術(shù)后48小時(shí)取出填塞物。圍手術(shù)期其他治療兩組均相同。記錄患者出血量及疼痛情況。并于填塞前后切取竇腔黏膜,行HE及免疫組化染色,同時(shí)抽取患者血液檢測(cè)血清IL-1、IL-4水平;(5)將上述觀察資料數(shù)據(jù)化處理后,采用統(tǒng)計(jì)學(xué)分析,得出相應(yīng)結(jié)論。結(jié)果:通過(guò)動(dòng)物實(shí)驗(yàn),發(fā)現(xiàn)三組家兔出血時(shí)間,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療組I與對(duì)照組I出血時(shí)間明顯低于正常對(duì)照組;肉眼觀察下,治療組II局部干燥,無(wú)明顯紅腫及滲出,對(duì)照組II局部有大量血水樣液體潴留,稍腫,膨脹海綿與周圍組織粘連明顯;填塞物周圍的組織HE染色切片提示,治療組II較對(duì)照組II術(shù)腔肌肉炎癥反應(yīng)輕微;鼻竇黏膜HE染色切片提示,治療組III較對(duì)照組III術(shù)腔黏膜出血少,炎癥反應(yīng)輕微。通過(guò)臨床實(shí)驗(yàn),發(fā)現(xiàn)兩組患者術(shù)后疼痛VAS評(píng)分無(wú)顯著性差異(P0.05);術(shù)后48小時(shí)內(nèi)出血量,差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組IV出血量明顯低于對(duì)照組IV;鼻竇黏膜HE染色切片提示,治療組IV較對(duì)照組IV術(shù)腔黏膜炎癥反應(yīng)輕微;鼻竇黏膜免疫組化染色切片提示,治療組IV在鼻竇黏膜上IL-1和IL-4的表達(dá)均低于治療組IV;兩組患者術(shù)后48小時(shí)外周血中炎癥因子(IL-1、IL-4)水平,差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組IV炎癥因子水平明顯低于對(duì)照組IV。結(jié)論:(1)通過(guò)動(dòng)物實(shí)驗(yàn),生肌通竅止血海綿局部止血作用明顯,并且有良好的組織相容性;(2)通過(guò)臨床研究,同樣證明了生肌通竅止血海綿對(duì)鼻竇炎內(nèi)鏡術(shù)后具有良好的止血作用,并能調(diào)節(jié)鼻竇黏膜IL-1和IL-4的表達(dá),對(duì)鼻竇炎患者血清IL-1和IL-4的表達(dá)也有調(diào)節(jié)作用,提示具有抗炎抑炎作用。(3)據(jù)此可以推斷生肌通竅止血海綿通過(guò)局部止血、調(diào)節(jié)炎癥因子的表達(dá)促進(jìn)鼻-鼻竇黏膜術(shù)后的修復(fù),值得進(jìn)一步研究和推廣。
[Abstract]:Objective: (1) to verify the myogenic Tongqiao hemostatic sponge on nasal endoscopic surgery postoperative cavity hemostasis and promoting effects in the repair of nasal cavity mucosa; (2) to explore the possible mechanism of myogenic Tongqiao hemostatic sponge hemostatic and nasal cavity mucosa repair; (3) confirmation of Chinese medicine in the nasal cavity and promote hemostasis the possibility of application in mucosal repair. Methods: (1) 30 rabbits were randomly divided into normal control group, control group I and group I, respectively incision in the back of rabbit bilateral symmetry, cut off the fascia to the natural flow of blood vessels, after the beginning of time, the normal control group did not intervene. The treatment group I and control group I were immediately Shengji Tongqiao hemostatic sponge, expansive sponge were placed in the incision bleeding, blood sucking to 1 by filter every 15s, until the blood natural stop, the whole process with the camera to record the bleeding, and the use of video analysis software The bleeding time; (2) 20 rabbits were randomly divided into treatment group and control group were II II, incision on the back of rabbit bilateral symmetry, respectively, myogenic Tongqiao hemostatic sponge, sponge in expansion of two groups of rabbits back incision, suture of incision, incision open after 48 hours, remove the stuffing observe, incision, and packing of surrounding tissue by HE staining detection; (3) 20 rabbits were randomly divided into treatment group and control group were III III, open the rabbit sinus from the nasal dorsal incision, respectively Shengji Tongqiao hemostatic sponge, sponge in sinus expansion, sutured. Cut open after 48 hours, remove the stuffing, observe the sinus and sinus mucosa HE staining; (4) met the diagnostic criteria and surgical indications of 60 cases of chronic sinusitis were selected into the group, were randomly divided into treatment group and control group IV IV, the two groups were routine nasal endoscope Endoscopic sinus surgery, the treatment group IV and control group IV after surgery respectively Shengji Tongqiao cavity hemostatic sponge and swelling sponge packing, after 48 hours out wadding. Perioperative treatment of the two groups were the same. Record the amount of bleeding and pain. And the sinus mucous membrane in packing before and after HE and immunohistochemical staining, detection of serum IL-1 and IL-4 levels in patients with blood extraction; (5) the observation data processing, statistical analysis, draw the corresponding conclusion. Results: through animal experiment, three rabbits bleeding time, the difference was statistically significant (P0.05) and I treatment group. The control group I the bleeding time was significantly lower than normal control group; visual observation, the treatment group II partial dry, no obvious swelling and exudation, the control group II has a large number of local blood samples and fluid retention, slightly swollen, expansive sponge adhesion with surrounding tissue significantly; packing material around Tissue HE staining indicated that the treatment group than the control group II II cavity muscle slight inflammation; sinus mucosa HE staining indicated that the treatment group than the control group III III nasal cavity mucosa bleeding, slight inflammatory reaction. Through clinical trials, found that two groups of patients with postoperative pain VAS scores had no significant difference (P0.05); the amount of bleeding within 48 hours after the surgery, the difference was statistically significant (P0.05), IV treatment group the amount of bleeding was significantly lower than the control group IV; sinus mucosa HE staining indicated that the treatment group than the control group IV IV of mucosa mild inflammatory reaction; sinus mucosa immunohistochemical staining indicated that the expression of IV IL-1 in the treatment group sinus mucosa and IL-4 in treatment group were lower than IV; 48 hours after operation in the two groups in the peripheral blood inflammatory factors (IL-1, IL-4) level, the difference was statistically significant (P0.05), treatment group IV inflammatory factor level was significantly lower than the control group IV. conclusion: (1) through animal The myogenic Tongqiao hemostatic sponge local hemostatic effect is obvious, and has good biocompatibility; (2) through clinical research, also proved that the myogenic Tongqiao hemostatic sponge has good hemostasis for sinusitis after endoscopic surgery, and can regulate the expression of IL-1 and IL-4 in sinus mucosa, the expression of IL-1 and IL-4 in serum of patients with sinusitis also has a regulatory role, suggesting that the anti-inflammatory anti inflammation effect. (3) we can deduce that the myogenic Tongqiao hemostatic sponge through local hemostasis, regulate the expression of inflammatory cytokines promote the repair of nasal sinus mucosa after operation, it is worthy of further research and promotion.

【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R276.1

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