尼卡地平对静脉移植物的保护作用

发布时间：2018-04-07 16:20

本文选题：冠状动脉旁路移植术　切入点：尼卡地平注射液　出处：《河北医科大学》2016年硕士论文

【摘要】：目的:冠状动脉旁路移植术是如今治疗冠心病的最可靠的手段之一,现阶段主要的静脉桥血管来源是大隐静脉,但是大隐静脉血管桥的十年通畅率远低于动脉桥,仅有50%-70%左右,因此,提高大隐静脉血管桥的通畅率至关重要。在手术过程中,大隐静脉的体外保存是冠状动脉旁路移植术的重要环节,也是影响术后近远期通畅率的重要方面,如果能为临床工作提供一种对静脉桥血管内皮细胞损害小,对血管的舒张作用好的保存液,必将极大提高冠状动脉旁路移植术的静脉桥血管近远期通畅率,促进搭桥手术进一步发展。尼卡地平注射液为二氢吡啶类Ca~(2+)通道阻滞剂,属于第二代钙拮抗药,它有抑制Ca~(2+)内流的作用,从而抑制cAMP磷酸二酯酶导致细胞cAMP不断上升,有强烈的扩张血管的作用,尤其对冠状动脉血管和脑血管作用明显。其性质稳定,疗效确切。本实验研究尼卡地平注射液对兔静脉血管的保护作用,与临床常用的罂粟碱做对比,为其作为冠脉搭桥术中静脉移植物的保存液用于临床提供理论依据。方法:1首先将家兔进行分组,将30只家兔随机分为三组,每组10只,空白组:肝素及生理盐水;对照组:肝素、罂粟碱及生理盐水;实验组:肝素、尼卡地平注射液及生理盐水。然后建立动物模型,取家兔颈外静脉4-5cm,将从各组家兔取下的颈外静脉放入相应保护液中浸泡30分钟,将取下的颈外静脉分为A、B两段,A段用于电镜及近期光镜检查,进行对比。B段用于与颈总动脉吻合,吻合完成后继续饲养,1个月后截取桥血管中间部,进行远期光镜检查。并应用ELISA法测定各保存液TXA2含量。2所得数据使用统计软件SPSS13.0进行统计数据分析。各组所得数据均进行正态性检验以及方差齐性检验。如果数据符合正态分布,且方差齐,即使用成组t检验来分析两组均数有无差异及差异的统计学意义。若符合正态但方差不齐,即用校正自由度后的t’检验比较两组均数有无差异及差异的统计学意义。若非正态且方差不齐,则使用非参数检验。若p0.05,则认为存在的差别具有统计学意义。结果:1实验近期研究指标:1)通过光学显微镜检查显示血管内皮细胞覆盖率得分分别为:空白组1.775±0.321分,对照组1.750±0.353分,实验组2.150±0.428分。三组数据首先进行正态性检验,均符合正态性分布再相互进行方差齐性检验及t检验,其结果为:对照组与空白组差异无统计学意义(p0.05),实验组与对照组差异有统计学意义(p0.05),实验组与空白组差异有统计学意义(p0.05)。实验结果表明近期光镜检测下,尼卡地平组血管内皮覆盖率高于罂粟碱组及肝素组,且有统计学意义,罂粟碱组血管内皮覆盖率与肝素组无统计学差异。2)通过电子显微镜检查显示实验组:部分标本可见内皮细胞少量脱落,视野下内皮细胞少见空泡及水肿,内皮细胞形态大多完整,细胞器少见异常,基底膜连续性好且与周围细胞连接紧密。对照组:标本多见内皮细胞脱落,视野下部分内皮细胞可见水肿,内皮细胞形态基本完整,基底膜连续性差或不连续,与周围细胞连接欠紧密。空白组:血管内皮细胞结构破坏严重,部分标本看不到完整内皮细胞,无连续性基底膜。3)各组保存液TXA2含量elisa检测法检测结果:TXA2含量实验组:48.434±12.161pg/ml,对照组:60.207±10.346pg/ml,空白组:60.457±12.272pg/ml。三组数据首先进行正态性检验,均符合正态性分布再相互进行方差齐性检验及t检验结果为:对照组与空白组差异无统计学意义(p0.05),实验组与对照组差异有统计学意义(p0.05),实验组与空白组差异有统计学意义(p0.05)。结果表明尼卡地平组TXA2含量低于罂粟碱组及肝素组,且有统计学意义,罂粟碱组TXA2含量与肝素组无统计学差异。2实验远期研究指标:通过光学显微镜检查显示血管内皮细胞覆盖率得分分别为:空白组1.550±0.197分,对照组1.600±0.316分,实验组1.975±0.321分。三组数据首先进行正态性检验,均符合正态性分布再相互进行方差齐性检验及t检验结果为:对照组与空白组差异无统计学意义(p0.05),实验组与对照组差异有统计学意义(p0.05),实验组与空白组差异有统计学意义(p0.05)。实验结果表明远期光镜检测下,尼卡地平组血管内皮覆盖率高于罂粟碱组及肝素组,且有统计学意义,罂粟碱组血管内皮覆盖率与肝素组无统计学差异。结论:1尼卡地平注射液比罂粟碱对兔静脉血管内皮细胞的有更好的保护作用。主要表现在对内皮细胞形态的保护及内皮细胞的覆盖率。2尼卡地平保存液保存的血管比罂粟碱保存液保存的血管产生的血栓素A2少。
[Abstract]:Objective: coronary artery bypass grafting is one of the most reliable means now in the treatment of coronary heart disease, the main source of vein grafts at this stage is of great saphenous vein, but the ten year patency rate of great saphenous vein artery is far below the bridge, only about 50%-70%, therefore, improve the patency rate of the saphenous vein during operation is very important. In the process of the great saphenous vein in vitro preservation is an important link of coronary artery bypass grafting, but also affect the postoperative patency as well as an important aspect of, if can provide a kind of vein graft vascular endothelial cells injury for clinical work, the vasorelaxing effect of the preservation solution, will greatly improve the long-term patency rate of nearly the vein grafts of coronary artery bypass grafting, and promote the further development of bypass surgery. Nicardipine injection for two dihydropyridine Ca~ (2+) channel blocker, which belongs to the second generation of calcium antagonists It has, the inhibition of Ca~ (2+) in the flow, thereby inhibiting phosphodiesterase cAMP induced cAMP rise, expansion of blood vessels strong role, especially on coronary artery and cerebrovascular function obviously. Its stability, curative effect. The experimental study on protective effect of nicardipine injection on rabbit vein and compared with the clinical commonly used papaverine, to provide the theory basis for the clinical as preservation of vein grafts in coronary artery bypass grafting. Methods: 1 rabbits were first grouped, 30 rabbits were randomly divided into three groups, 10 rats in each group: blank group, saline control group and heparin; heparin. Papaverine and saline; experimental group: heparin, nicardipine injection and normal saline. Then on the establishment of animal models, the rabbit jugular vein 4-5cm from rabbits in each group were taken from the jugular vein into the corresponding protective liquid for 30 minutes, will Remove the external jugular vein was divided into A, B two, A section for electron microscopy and light microscopy in comparison to.B, consistent with the common carotid artery, anastomosis after feeding, 1 months after the interception of vascular bridge in middle part of the forward light microscopic examination and determination of TXA2 content. The data of the.2 preservation solution for statistical data analysis using statistical software SPSS13.0 using ELISA method. The data was evaluated using the test of normality and homogeneity of variance test. If the data to conform to normal distribution, and variance, namely the use of group t test to analyze the two groups have no significant difference and difference. If the line is but the state variance not neat, with degrees of freedom correction after t test between two groups had no statistically significant difference and difference. If the normality and homogeneity of variance, non parametric test. If P0.05, believes that the difference has statistical significance. Results: 1 Experimental Study: 1) the recent index by optical microscope showed that vascular endothelial cell coverage score respectively: blank group 1.775 + 0.321, 1.750 + 0.353 in control group, experimental group 2.150 + 0.428 points. The first three sets of data normality test, accord with the normal distribution to each other homogeneity of variance test and t test, the results are as follows: the differences between the two groups and the control group had no statistical significance (P0.05), the experimental group and the control group was statistically significant (P0.05), there was statistically significant difference between the experimental group and the control group (P0.05). The experimental results show that the light microscope detection, nicardipine group blood vessels endothelial coverage rate is higher than the papaverine group and heparin group, and there was statistical significance, papaverine group vascular endothelial coverage and the heparin group showed no significant difference.2) showed that the experimental group by electron microscopy: endothelial cells were seen as a little off, Wild endothelial cells under rare vacuoles and edema, endothelial cells are mostly intact organelles, rare anomalies, basement membrane continuity and closely connected with the surrounding cells. Control group: specimens of rare endothelial cell loss, from the perspective of some endothelial cells edema, endothelial cells form the basic integrity of basement membrane, poor continuity or not continuously, with the surrounding cells connected closely. In the blank group: the structure of vascular endothelial cells were severely damaged, can not see the complete discontinuity of endothelial cells, basement membrane.3) were stored testing results of TXA2 content of the liquid ELISA method: the content of TXA2 in experimental group: 48.434 + 12.161pg/ml, 60.207 + 10.346pg/ml, the control group: blank group 12.272pg/ml.: 60.457 + three group data first normality test, accord with the normal distribution and mutual homogeneity of variance test and t test results: differences in control group and blank group had no statistical significance (P 0.05), the experimental group and the control group was statistically significant (P0.05), there was statistically significant difference between the experimental group and the control group (P0.05). The results showed that nicardipine group TXA2 was lower than that of papaverine group and heparin group, and there was statistical significance, TXA2 content of papaverine group and heparin group showed no significant difference.2 test index: long-term research through the optical microscope showed that vascular endothelial cell coverage score respectively: blank group 1.550 + 0.197, 1.600 + 0.316 in control group, experimental group 1.975 + 0.321 points. The first three sets of data normality test, accord with the normal distribution of each other by homogeneity test of variance and t test results: differences in control group and blank group had no statistical significance (P0.05), the experimental group and the control group was statistically significant (P0.05), there was statistically significant difference between the experimental group and the control group (P0.05). The experimental results show that the forward light detection, Nicardipine group vascular endothelial coverage rate is higher than the papaverine group and heparin group, and there was statistical significance, papaverine group vascular endothelial coverage and the heparin group showed no significant difference. Conclusion: 1 nicardipine injection protection than papaverine on rabbit vein endothelial cells have better effect. Mainly in the protection of endothelial cell morphology and endothelial cell coverage.2 nicardipine solution in preservation of the vascular preservation of thromboxane A2 less saved than papaverine.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R654.2

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