主动脉套环吻合技术的急性动物实验研究

发布时间：2018-01-12 11:42

本文关键词：主动脉套环吻合技术的急性动物实验研究　出处：《南华大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的为了检验主动脉套环吻合方法是否在操作耗时，术后吻合口出血发生率优于普通针线吻合。方法选择体重在15-20kg，年龄2-5岁、健康状况良好的杂种犬15只。用套环吻合方法吻合主动脉的杂种犬为实验组，用普通方法吻合主动脉的杂种犬为对照组。预实验5只（根据实验的情况对主动脉套环的设计进行改进，先后进行了5次预实验），正式实验10只，雌雄不限，随机分实验组5只，对照组5只。所有实验犬均在气管插管全麻下行正中开胸建立体外循环。停跳液为冷晶体停跳液。记录体外循环时间，主动脉阻断时间，血管吻合时间。实验组采用主动脉套环吻合方法。主动脉套环吻合方法属于机械性血管吻合技术的一种。经过5次预实验，反复改进套环设计及手术操作，目前初步成型。套环吻合装置分为3部分：近心端套环，人工血管，远心端套环。套环动物实验采用不锈钢材料。近心端套环近心一端有2个U缺口（中心相隔套环1/3圆周），套环边缘打孔数个；套环远心一端为宽凹槽。远心端套环仅有一个宽凹槽。其吻合原理为:实验前预先将套环套入相同口径人工血管中，近心端套环用6X14涤纶线通过套环的孔及7号黑丝线结扎于宽凹槽固定人工血管及套环，远心端用7号黑丝线直接结扎固定，近心端2个U形缺口处去除部分人工血管；实验时将预制好的套环及人工血管组件近心端两个2个U形缺口对应狗的左右冠状动脉开口，予涤纶针线穿过缺口间的孔缝在主动脉根部(尽可能缝在主动脉瓣环上)，，穿过主动脉壁打结，置入组件近心端，于7号丝线结扎固定组件；同法连接远心端套环。具体如下：实验组（套环吻合）：实验犬心脏停跳后，在窦管交界上1cm剪开主动脉，方法同上。心脏复跳后，观察套扎处有无出血。并记录体外循环时间，主动脉阻断时间，主动脉套扎吻合时间，停机时的心率、平均动脉压。对照组(传统吻合)：于心脏停跳后，剪除部分升主动脉，用人工血管吻合主动脉。心脏复跳后，观察吻合口有出血量。记录体外循环时间，主动脉阻断时间及主动脉套扎吻合时间，停机时的心率、平均动脉压。结果实验组：体外循环时间分别为：9，8，8，7，6min；主动脉阻断时间分别为：4.5，4，4，3.5，3min；主动脉套扎吻合时间分别为：4，3.5，3.5，3，2.5min；停机时的心率分别为：160,179,170,172,165次/min；停机时的平均动脉压分别为：106,100,108,112,104mmHg。对照组：体外循环时间分别为：17，16，17，18，18min；主动脉阻断时间分别为：8.5，8，8.5，9，9min；主动脉吻合时间分别为：8，7.5，8，8.5，8min；停机时的心率分别为：172,170,167,168,173次/min；停机时的平均动脉压分别为：102,108,107,103,105mmHg。所有实验犬开放循环后心脏均能成功复跳。结论主动脉套环吻合方法吻合操作时间短，术后吻合口出血发生率低，明显优于主动脉普通针线吻合；主动脉套环对冠状动脉灌注无影响。
[Abstract]:Objective to investigate whether aortic ring anastomosis is time-consuming, the incidence of postoperative anastomotic bleeding is better than that of common needle and thread anastomosis. Methods Fifteen mongrel dogs with a body weight of 15-20 kg, ages 2-5 years old and good health condition were selected as experimental group, which were anastomosed with aorta by ring anastomosis. Five mongrel dogs with common aortic anastomosis were used as control group. (according to the experimental conditions, the design of aortic ring was improved, 5 times of pre-experiment and 10 cases of formal experiment were carried out. Male and female were randomly divided into experimental group (n = 5) and control group (n = 5). Cardiopulmonary bypass (CPB) was established in all dogs under general anesthesia under tracheal intubation. The cardiopulmonary bypass (CPB) was recorded in the cardiopulmonary bypass (CPB) solution. Aorta occlusion time and vascular anastomosis time. Aortic ring anastomosis was used in the experimental group. Aortic ring anastomosis was one of the mechanical vascular anastomosis techniques. The design and operation of the ring were improved repeatedly. The ring anastomosis device is divided into three parts: the proximal ring and the artificial blood vessel. Ring at the distal end. Stainless steel is used in the animal experiment of the ring. There are two U notches at the proximal end of the ring (the center is separated from the ring by 1/3 circumference and several holes are made at the edge of the ring; The ring has a wide groove at the distal end of the ring and only one wide groove at the distal end of the ring. The matching principle is that the ring is placed in the same diameter artificial blood vessel in advance before the experiment. The proximal ring was fixed with 6X14 polyester thread through the hole of the ring and the No.7 black silk wire was ligated to the wide groove to fix the artificial blood vessel and ring, and the distal end was directly ligated with the 7 # black wire. Two U-shaped notches at the proximal end of the heart removed some of the artificial blood vessels. In the experiment, two U-shaped gaps of the prefabricated ring and the proximal end of the artificial vascular module were matched to the left and right coronary artery openings of the dog. Give polyester thread through the hole between the holes in the root of the aorta (as far as possible sewn in the aortic annulus, through the aortic wall knot, into the proximal end of the component, ligation of the fixed assembly at the 7th silk thread; Connect the concentric ring with the same method. The details are as follows: In the experimental group (ring anastomosis: after cardiac arrest, the aorta was cut 1 cm above the junction of the sinus canal. Methods after resuscitation, the bleeding was observed and the time of cardiopulmonary bypass was recorded. Aortic clamping time, aortic ligation and anastomosis time, heart rate at rest, mean arterial pressure. Control group (traditional anastomosis: after cardiac arrest, cut off part of ascending aorta. Aortic anastomosis was performed with artificial blood vessels. After cardiac resuscitation, the amount of bleeding in anastomotic stoma was observed. The time of extracorporeal circulation, the time of aortic occlusion, the time of aortic ligation and anastomosis, and the heart rate at the time of stopping were recorded. Results the mean arterial pressure in the experimental group: the time of cardiopulmonary bypass (CPB) was 7 minutes. The aortic clamping time was 4: 4.5, 4? 3? 5??? The time of aortic ligation and anastomosis was 2.5 min; The heart rate was 165 / min at 1: 160, 179 / 170 / 172g / min, respectively. The mean arterial pressure at the end of the operation was 10 / 106 / 100 / 108t / 1012 / 104mm / g, respectively. In the control group, the CPB time was 1 / 1716 / 100 / 100 / 108mm / 104mm / g, respectively, and the time of CPB was 18min / min, respectively. The aortic clamping time was 8. 5 and 8. 5 and 9 minutes, respectively. The anastomosis time of aorta was 8: 8 min. The heart rate at downtime was 1: 172, 170, 167, 168, 173 / min, respectively. The mean arterial pressure at the end of the operation was 10 / 102 / 108 / 107 / 103mm / 105mm Hg.All the dogs were able to repulse successfully after open circulation. Conclusion the operation time of aortic ring anastomosis is short, and the incidence of anastomotic bleeding is lower, which is better than that of common aortic needle and line anastomosis, and the aortic ring has no effect on coronary artery perfusion.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R-332

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