不同构型人工瓣二尖瓣置换猪模型建立的实验研究（国家自然科学基金资助项目）

发布时间：2018-04-22 00:10

  本文选题：猪 + 二尖瓣置换　； 参考：《昆明医学院》2011年硕士论文

【摘要】：目的：建立猪二尖瓣置换(MVR)动物模型,探讨影响该动物模型成功建立的关键因素,评估模型建立的价值和可操作性。在此基础上比较不同构型人工瓣膜下游血流动力学的优劣,为进一步研究人工心瓣下游血流动力学与瓣膜及其瓣下结构保留术式之间的相互关系提供方法学基础。 方法：选择滇南小耳猪封闭群7头,采用全麻体外循环下经左心耳入路行保留全瓣瓣下结构的二尖瓣置换术的方法建立动物模型,根据所替换人工瓣膜类型分为三组：单叶机械瓣组(n=2)；双叶机械瓣组(n=3)；生物瓣组(n=2)。在模型建立的基础上通过与计算机图像分析相结合的彩色多谱勒超声技术评估手术前后心脏的结构功能与血流动力学等指标,并对不同构型人工瓣膜下游湍流剪应力进行对比分析。 结果：各组动物模型均顺利建立,平均手术时间175.0±38.9min,平均转流时间103.8±17.7min,平均阻断时间51.2±17.8min,平均辅助时间31.2±5.7min,预充血量555.5±46.3m1,转流中鼻温平均28.5±1.4℃。常规血流动力学指标比较结果显示：手术前后心率(HR)比较差异有统计学意义(P0.05)；手术前后平均动脉压(MAP),中心静脉压(CVP)无统计学意义(P0.05)。常规彩色超声指标比较结果显示：手术前后左室射血分数(LVEF)、左室短轴缩短率(LVFS)、左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)无统计学意义(P0.05)。血气生化指标比较结果显示：术中转流同术前相比,PH值差异无统计学意义(P0.05); PaO2、BE、Hb、K+差异有统计学意义(P0.05)；术后2h同术前相比：PH值、K+、BE差异无统计学意义(P0.05), PaO2、Hb差异有统计学意义(P0.05)。心瓣流体力学指标比较结果显示：不同构型人工瓣膜术后核心位点湍流剪应力(TSS)差异无统计学意义(P0.05)；边界位点TSS差异有统计学意义(P0.05)。 结论：本研究建立猪的MVR动物模型能真实客观地模拟人体MVR的血流动力学状况,该方法科学可靠,可行性强。保留全瓣瓣下结构人工心瓣下游TSS的对比分析显示：单叶机械瓣最大,双叶机械瓣次之,生物瓣最小；研究结果提示：三种不同构型人工瓣膜中,其血流动力学性能以生物瓣较佳,单叶机械瓣较差,双叶机械瓣介于两者之间。从人工瓣膜最小应力原则考虑,目前机械瓣的血流动力学性能有进一步改善的必要。
[Abstract]:Objective : To establish an animal model of porcine mitral valve replacement , to discuss the key factors influencing the success of the animal model and to evaluate the value and operability of the model .

Methods : 7 patients were selected from the closed group of small ear pig in southern Yunnan province . The model was established by the method of left atrial appendage valve replacement under cardiopulmonary bypass . The model was divided into three groups according to the type of replacement prosthetic valve : single lobe mechanical valve group ( n = 2 ) ;
Two - leaf mechanical valve group ( n = 3 ) ;
The structure function and hemodynamics of the heart before and after operation were evaluated by the color Doppler ultrasound technique combined with computer image analysis based on the model establishment , and the turbulent shear stress downstream of the artificial valve in different configurations was analyzed .

Results : The average operative time was 175.0 卤 38.9min , the mean transit time was 103.8 卤 17.7min , the mean blocking time was 51.2 卤 17.8min , the mean duration of auxiliary time was 37.2 卤 5.7min , the pre - filling volume was 555 . 5 卤 46.3m1 , the mean nasal temperature was 28.5 卤 1.4 鈩，

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