负压吸引法在静脉淤血皮瓣动物模型中的实验研究
发布时间：2019-06-26 22:15
【摘要】：目的：⑴在静脉淤血皮瓣不同位置放置负压引流管后皮瓣形态学变化及差异。⑵不同位置放置负压引流管对于静脉淤血皮瓣微循环及皮瓣氧代谢的影响。⑶负压吸引与淤血静脉再通对于静脉淤血皮瓣微循环及氧代谢影响的比较。通过观察研究负压吸引法对静脉淤血皮瓣治疗后微循环的变化，探索简便有效救治静脉淤血皮瓣的方法，为进一步指导临床工作提供新的思路和理论基础。 方法： 1实验动物：新西兰长耳白兔健康清洁级40只，雌雄各半，体重质量2.5~3kg。 2动物模型建立：于皮瓣模型制作前三天，各组白兔行5%硫化钠腹部脱毛，脱毛面积从两侧腹股沟向上至剑突水平，两侧脱毛至腋中线范围内，温水冲洗自然晾干后用纱布垫及弹力网套包扎好，以保温并防止腹部皮肤与笼网挫伤。盐酸塞拉嗪（速眠新）和氯胺酮1:1等比例配好，按照0.2ml/kg体重肌肉内注射进行麻醉，根据麻醉情况可于1小时后再次追加0.1ml/kg剂量药液维持麻醉。麻醉成功后，取仰卧位，将其四肢捆绑于兔台上，，捆绑牙线防止咬伤。0.5%碘伏消毒术区，于兔下腹部以腹壁下浅静脉为轴心设计轴行皮瓣，面积约12×4cm，并依据分组对相应血管进行处理。 3实验动物分组：每只新西兰长耳白兔做两个下腹部皮瓣，采用随机数字分配法，将80个皮瓣分为4组，即对照组，近端引流组，远端引流组和静脉再通组。每组共20个皮瓣，每组内再采用随机数字分配法将每组20个皮瓣分为扫描皮瓣12个，取材皮瓣8个。 4激光多普勒扫描：采用丹麦产lasa激光多普勒微循环图像仪进行兔腹部皮瓣的扫描。分别扫描手术后2h、4h、8h、24h、3d和7d的结果。 5取材：4个组共计取材皮瓣32个，取材选择于术后即刻、4h、8h、24h、3d、7d六个时间点，将皮瓣分成上、中、下三个区域，于各个区域同一时间点分别切取0.5×0.5cm皮肤。 6检测方法及观测指标： 6.1激光多普勒扫描成像仪扫描皮瓣特定区域，记录皮瓣微循环血流量数据结果。 6.2皮瓣组织丙二醛（Maleic Dialdehyde MDA）分光光度法监测：对取样组织首先进行匀浆处理，将匀浆组织进行水浴离心后，取上清液，依照南京建成MDA试剂盒要求，进行分光光度计比色，测算MDA含量。 7统计学处理：所有实验数据以均数±标准差（x±s）表示，采用spss13.0进行检验，显著性分析以p 0.05为差异具有统计学意义。 结果： 1大体观察结果：皮瓣制备后4小时，各组皮瓣均出现肿胀，皮瓣远端呈现暗紫色，对照组肿胀最为明显，肿胀面积最大；24小时后各组皮瓣肿胀进一步加重，对照组肿胀进一步加重，同时皮瓣远端大约1/3面积颜色呈暗紫色，斑片状黑褐色痂皮形成。 近端引流组和远端引流组及静脉再通组皮瓣肿胀较对照组轻微，暗紫色面积小。远端引流组引流液约为2ml，明显多于较近端引流组。 3天后各组皮瓣暗紫区域与正常区域界限逐渐明显，近端引流组和远端引流组及静脉再通组皮瓣暗紫区域明显小于对照组皮瓣。7天后皮瓣远端部分坏死区域黑色痂皮形成，界限清楚。 2激光多普勒成像仪结果： 2.1皮瓣远段1/3区域手术后4h、8h、24h、3d及7d，近端引流组、远端引流组、再通组均与对照组间皮瓣微循环血流量数据结果进行比较有统计学意义（P0.05）。手术后24小时，远端引流组、再通组分别与近端引流组间比较有统计学意义（P0.05）。 2.2皮瓣中1/3区域手术后4h、8h、24h、3d及7d，近端引流组、远端引流组、再通组均与对照组间皮瓣微循环血流量数据结果进行比较有统计学意义（P0.05）。手术后3天，远端引流组、再通组分别与近端引流组间比较有统计学意义（P0.05）。 2.3皮瓣近段1/3区域手术后4h、8h、24h、3d及7d，近端引流组、远端引流组、再通组均与对照组间皮瓣微循环血流量数据结果进行比较有统计学意义（P0.05）。手术后3d及手术后7d，近端引流组、再通组与远端引流组间有统计学意义（P0.05）。 3丙二醛结果：经测定皮瓣远、中、近3个区域内丙二醛的含量，进行比较由远段到近段丙二醛含量逐渐降低，术后4h、8h、24h各组皮瓣远、中、近段间丙二醛含量间有统计学意义（P0.05）；术后3d各组皮瓣内丙二醛含量达到峰值，皮瓣远端区域再通组与近端引流组及远端引流组间有统计学差异（P0.05）。3d之后各组间无统计学差异（P0.05）。 结论： 1负压吸引法可以有效减轻静脉淤血皮瓣的肿胀和淤血范围。 2静脉淤血皮瓣早期（术后3天）可出现皮瓣缺氧而引起氧代谢障碍，皮瓣远端区域缺氧损伤更加明显，再通淤血静脉后皮瓣远端出现缺氧加重情况，可能为缺血再灌注对皮瓣造成的二次缺血所导致。 3早期在皮瓣远端放置负压引流可有效改善皮瓣远端的血液循环；于皮瓣蒂部放置负压引流可有效促进皮瓣近端的血液循环，有利于皮瓣近段的后期愈合。在皮瓣远端区域，负压吸引与再通淤血静脉后治疗效果无差异，可以有效促进皮瓣远端的皮瓣后期愈合，提高静脉淤血皮瓣的救治成活率。
[Abstract]:Objective: To observe the morphological changes and differences of the skin flap after placement of the negative pressure drainage tube in different positions of the venous blood flap. The effect of the negative pressure drainage tube on the microcirculation and the oxygen metabolism of the skin flap in different positions of the skin flap. Comparison of the effects of negative pressure suction and blood stasis on microcirculation and oxygen metabolism in venous congestion skin flap. By observing the changes of the microcirculation after the treatment of the venous congestion skin flap by the study of the negative pressure suction method, the method of simple and effective treatment of the venous congestion flap is explored, and a new train of thought and theoretical basis for further guiding the clinical work is provided. square Method:1 experimental animal:40 healthy clean-grade white rabbits of New Zealand white rabbit, half of male and female, and 2.5 to 2.5 weight of body weight. 3 kg.2 animal model:3 days before the skin flap model was made,5% sodium sulfide in each group was depilated in the abdomen, the area of the epilation was up to the level of the swordhead from the groin on both sides, the two sides were depilated to the middle of the middle line of the axilla, the warm water was washed naturally, and then the gauze pad and the elastic force were used. The net cover is wrapped up to keep the heat and prevent the abdominal skin And the dosage of 0.1 ml/ kg can be further added after 1 hour according to the anesthesia condition. The solution is maintained for anesthesia. After the anesthesia is successful, the supine position is taken, and the four limbs are bound on the rabbit table, and the dental floss is used for preventing the bite. The 0.5% iodine-V disinfection area is designed on the lower abdomen of the rabbit with a superficial vein under the abdominal wall as an axial center, the area is about 12 to 4 cm, and the corresponding blood is based on the grouping. tubes were treated.3 experimental animals: two lower abdominal skin flaps per New Zealand long-ear white rabbit, and 80 flaps were divided into 4 groups, i.e., the control group, the proximal drainage group, the distal drainage group, A total of 20 skin flaps in each group were divided into two groups. and 8.4 laser Doppler scanning: using the lasa laser Doppler microcirculatory image instrument in Denmark The scanning of the abdominal skin flap of rabbits was performed. After the operation, the operation was 2 h,4 h,8 h,24 h, respectively. The results of 3 days and 7 days were divided into four groups:32 of the total skin flaps,4 h,8 h,24 h,3 d and 7 d after operation, and the skin flap was divided into upper, middle and lower three regions, and cut out at the same time point in each region. 0.5 to 0.5 cm skin .6 Test method and observation index: 6.1 The laser Doppler scanning imager scans the specific area of the skin flap. And recording the blood flow data of the micro-circulation blood flow of the skin flap. Carry out the colorimetric analysis of the spectrophotometer and calculate the content of MDA.7 Statistics: All the experimental data are expressed in the mean square standard deviation (x% s), and the test is performed by using the spss13.0. sex analysis The results were as follows:1 general observation:4 hours after the preparation of the skin flap, the skin flap of each group had swelling, the distal end of the flap showed dark purple, the swelling of the control group was the most obvious, the swelling area was the largest, and 24 hours The swelling of the skin flap in the control group was further increased, and the swelling of the control group was further increased, while the distal end of the flap was large Approximately 1/3 of the area is dark purple, and plaque-like black-brown skin is formed. The proximal and distal drainage groups The skin flap of the flow group and the venipuncture group was slightly swollen and the dark purple area was small. The drainage fluid of the distal drainage group was about 2 ml, which was significantly more than that of the proximal drainage group. After 3 days, the dark purple region and the normal area of the skin flap gradually became clear, and the dark purple region of the proximal drainage group and the distal drainage group and the venipuncture group was significantly smaller than that of the control group. Skin flap. The distal part of the skin flap after 7 days The black skin of the necrotic area was formed and the boundary was clear. The results of the laser Doppler imaging were as follows: 2.1 The distal segment 1/3 of the skin flap was 4 h,8 h,24 h,3 d and 7 d after the operation, and the proximal drainage group, the distal drainage group, the re-communication group and the control group. The data of the microcirculatory flow of the skin flap was statistically significant (P <0.05). The distal end of the flap was 24 hours after the operation. There was a statistically significant difference between the drainage group and the other group (P0.05). The 1/3 area of the flap was 4 h,8 h,24 h,3 d and 7 d after the operation, and the proximal drainage group, the distal drainage group and the re-passage group were compared with those of the proximal drainage group. The data of the microcirculatory blood flow in the control group was statistically significant (P0.05). There was a significant difference between the two groups in the distal drainage group and the proximal drainage group (P0.05). The data of the microcirculatory blood flow of the flap in the control group was statistically significant (P0.05). The content of malondialdehyde (MDA) in the proximal drainage group, the proximal drainage group, the reperfusion group and the distal drainage group was statistically significant (P0.05). The results of the malondialdehyde (MDA) were as follows: the content of the malondialdehyde (MDA) in the distal, middle and proximal regions of the skin flap was gradually decreased, and the content of the MDA in the proximal section and the proximal section was gradually decreased, and 4 hours after the operation. The content of malondialdehyde (MDA) in the distal region of the skin flap reached the peak, and the distal region of the flap was connected with the proximal drainage group and the distal drainage group. flow group There was a statistical difference (P0.05). There was no statistical difference between the groups after 3 d. Conclusion: The first negative pressure suction method can effectively reduce the swelling and blood stasis of the venous congestion skin flap. The early (3 days after operation) of the venous congestion flap may cause the oxygen metabolism disorder caused by the hypoxia of the skin flap, and the oxygen-deficient injury in the distal region of the skin flap is more clear. In the early stage, the distal end of the skin flap was placed with negative pressure drainage, which could effectively improve the distal flap. The blood circulation at the end of the skin flap is effectively promoted, the blood circulation at the proximal end of the skin flap can be effectively promoted, the later healing of the proximal end of the skin flap is facilitated, and the negative pressure suction and the recanalization are in the far-end region of the skin flap.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R-332
本文编号：2506543
[Abstract]:Objective: To observe the morphological changes and differences of the skin flap after placement of the negative pressure drainage tube in different positions of the venous blood flap. The effect of the negative pressure drainage tube on the microcirculation and the oxygen metabolism of the skin flap in different positions of the skin flap. Comparison of the effects of negative pressure suction and blood stasis on microcirculation and oxygen metabolism in venous congestion skin flap. By observing the changes of the microcirculation after the treatment of the venous congestion skin flap by the study of the negative pressure suction method, the method of simple and effective treatment of the venous congestion flap is explored, and a new train of thought and theoretical basis for further guiding the clinical work is provided. square Method:1 experimental animal:40 healthy clean-grade white rabbits of New Zealand white rabbit, half of male and female, and 2.5 to 2.5 weight of body weight. 3 kg.2 animal model:3 days before the skin flap model was made,5% sodium sulfide in each group was depilated in the abdomen, the area of the epilation was up to the level of the swordhead from the groin on both sides, the two sides were depilated to the middle of the middle line of the axilla, the warm water was washed naturally, and then the gauze pad and the elastic force were used. The net cover is wrapped up to keep the heat and prevent the abdominal skin And the dosage of 0.1 ml/ kg can be further added after 1 hour according to the anesthesia condition. The solution is maintained for anesthesia. After the anesthesia is successful, the supine position is taken, and the four limbs are bound on the rabbit table, and the dental floss is used for preventing the bite. The 0.5% iodine-V disinfection area is designed on the lower abdomen of the rabbit with a superficial vein under the abdominal wall as an axial center, the area is about 12 to 4 cm, and the corresponding blood is based on the grouping. tubes were treated.3 experimental animals: two lower abdominal skin flaps per New Zealand long-ear white rabbit, and 80 flaps were divided into 4 groups, i.e., the control group, the proximal drainage group, the distal drainage group, A total of 20 skin flaps in each group were divided into two groups. and 8.4 laser Doppler scanning: using the lasa laser Doppler microcirculatory image instrument in Denmark The scanning of the abdominal skin flap of rabbits was performed. After the operation, the operation was 2 h,4 h,8 h,24 h, respectively. The results of 3 days and 7 days were divided into four groups:32 of the total skin flaps,4 h,8 h,24 h,3 d and 7 d after operation, and the skin flap was divided into upper, middle and lower three regions, and cut out at the same time point in each region. 0.5 to 0.5 cm skin .6 Test method and observation index: 6.1 The laser Doppler scanning imager scans the specific area of the skin flap. And recording the blood flow data of the micro-circulation blood flow of the skin flap. Carry out the colorimetric analysis of the spectrophotometer and calculate the content of MDA.7 Statistics: All the experimental data are expressed in the mean square standard deviation (x% s), and the test is performed by using the spss13.0. sex analysis The results were as follows:1 general observation:4 hours after the preparation of the skin flap, the skin flap of each group had swelling, the distal end of the flap showed dark purple, the swelling of the control group was the most obvious, the swelling area was the largest, and 24 hours The swelling of the skin flap in the control group was further increased, and the swelling of the control group was further increased, while the distal end of the flap was large Approximately 1/3 of the area is dark purple, and plaque-like black-brown skin is formed. The proximal and distal drainage groups The skin flap of the flow group and the venipuncture group was slightly swollen and the dark purple area was small. The drainage fluid of the distal drainage group was about 2 ml, which was significantly more than that of the proximal drainage group. After 3 days, the dark purple region and the normal area of the skin flap gradually became clear, and the dark purple region of the proximal drainage group and the distal drainage group and the venipuncture group was significantly smaller than that of the control group. Skin flap. The distal part of the skin flap after 7 days The black skin of the necrotic area was formed and the boundary was clear. The results of the laser Doppler imaging were as follows: 2.1 The distal segment 1/3 of the skin flap was 4 h,8 h,24 h,3 d and 7 d after the operation, and the proximal drainage group, the distal drainage group, the re-communication group and the control group. The data of the microcirculatory flow of the skin flap was statistically significant (P <0.05). The distal end of the flap was 24 hours after the operation. There was a statistically significant difference between the drainage group and the other group (P0.05). The 1/3 area of the flap was 4 h,8 h,24 h,3 d and 7 d after the operation, and the proximal drainage group, the distal drainage group and the re-passage group were compared with those of the proximal drainage group. The data of the microcirculatory blood flow in the control group was statistically significant (P0.05). There was a significant difference between the two groups in the distal drainage group and the proximal drainage group (P0.05). The data of the microcirculatory blood flow of the flap in the control group was statistically significant (P0.05). The content of malondialdehyde (MDA) in the proximal drainage group, the proximal drainage group, the reperfusion group and the distal drainage group was statistically significant (P0.05). The results of the malondialdehyde (MDA) were as follows: the content of the malondialdehyde (MDA) in the distal, middle and proximal regions of the skin flap was gradually decreased, and the content of the MDA in the proximal section and the proximal section was gradually decreased, and 4 hours after the operation. The content of malondialdehyde (MDA) in the distal region of the skin flap reached the peak, and the distal region of the flap was connected with the proximal drainage group and the distal drainage group. flow group There was a statistical difference (P0.05). There was no statistical difference between the groups after 3 d. Conclusion: The first negative pressure suction method can effectively reduce the swelling and blood stasis of the venous congestion skin flap. The early (3 days after operation) of the venous congestion flap may cause the oxygen metabolism disorder caused by the hypoxia of the skin flap, and the oxygen-deficient injury in the distal region of the skin flap is more clear. In the early stage, the distal end of the skin flap was placed with negative pressure drainage, which could effectively improve the distal flap. The blood circulation at the end of the skin flap is effectively promoted, the blood circulation at the proximal end of the skin flap can be effectively promoted, the later healing of the proximal end of the skin flap is facilitated, and the negative pressure suction and the recanalization are in the far-end region of the skin flap.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R-332
【引证文献】
相关硕士学位论文 前1条
1 刘永红;不同位置的负压吸引法对静脉淤血皮瓣微血管的影响[D];河北医科大学;2013年
本文编号：2506543
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