羊膜防治心包缺损致粘连的作用研究
发布时间：2018-10-19 11:48
【摘要】：目的:为心胸外科二次手术创造较好的局部手术环境,本研究在模拟开胸术基础上探讨新鲜人羊膜(human amniotic membrane,HAM)对兔心包缺损后修复心包膜的效果及对心脏与周围组织粘连的影响。方法:健康新西兰大白兔54只随机分为对照组、模型组(心包缺损)和HAM组(HAM修复缺损心包),其中对照组18只仅行开胸手术,心包不做其他处理;模型组18只行开胸术后造心包缺损模型后擦心外膜,HAM组18只行开胸术后造心包缺损模型后擦心外膜并采用新鲜双层HAM修复心包膜,操作完毕后均常规关闭胸腔,留置胸腔引流管。术后30、60和180天分别进行心功能检测、心脏粘连和纤维化程度的宏观和微观评价及心肌组织病理学检查。结果:(1)培养HAM后的培养基上清液中表达白细胞介素-10(Interleukin-10,IL-10),高表达基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9),不表达转化生长因子-β3(Transforming grow factor-β3,TGF-β3)。(2)术后观察180天,对照组和HAM组无动物死亡,模型组动物死亡率为15%,各组之间比较差异无统计学意义(P0.05)。(3)第30天,三组动物心功能指标LVSP、LVEDP、HR、+Max d P/dt和-Min d P/dt之间比较,差异无统计学意义(P0.05);第60天,对照组和HAM组的+Max d P/dt明显高于模型组(P0.05);第180天,对照组、HAM组和模型组+Max d P/dt值分别为4684.61±452.03、4784.30±373.61和3044.69±379.90,-Min d P/dt值则为-3161.58±739.91、-3437.87±421.84和-2278.57±325.89,对照组和HAM组+Max d P/dt值和-Min d P/dt值均高于模型组(P0.05),其余四项心功能指标三组之间比较,差异无统计学意义(P0.05)。(4)第30天,对照组无明显粘连发生,HAM组和模型组的宏观粘连评分均为轻度,两组之间比较差异无统计学意义(P0.05);第60天,HAM组宏观粘连评分值为1.33±0.52,明显低于模型组中度粘连的值2.5±0.55(P0.05);第180天,对照组、模型组和HAM组宏观粘连评分值分别为0、2.4±0.55和1.17±0.41,即模型组宏观粘连评分值明显高于HAM组(P0.05)。(5)HE染色后,显微镜下可见,模型组心肌与周围组织粘连随观察时间延长,呈进行性加重趋势,粘连纤维化分级1-2,炎症分级0-2,而HAM组心肌与周围组织粘连180天时明显减轻,粘连纤维化分级0-1,炎症分级0-1,粘连极易分离,HAM已大部分被吸收,三组心肌细胞损伤均不明显。结论:(1)HAM的分泌物中表达IL-10,高表达MMP-9,不表达TGF-β3。(2)直接剪除心包膜+摩擦心室壁和空气暴露所致的心包缺损模型,60天至180天出现明显的心脏与周围组织的轻中度粘连,且心功能呈进行性的心室收缩性能与舒张性能的下降。(3)发现HAM修补心包膜缺损的新西兰兔模型具有明显的防治心脏与周围组织器官粘连的良好疗效,并有利于保持心脏功能正常,其防粘连作用可能与HAM分泌IL-10和MMP-9有关。
[Abstract]:Objective: to create a better local operation environment for the secondary operation of cardiothoracic surgery. The purpose of this study was to investigate the effect of fresh human amniotic membrane (human amniotic membrane,HAM) on the repair of pericardial membrane after pericardial defect in rabbits and its effect on the adhesion between heart and surrounding tissues on the basis of simulated thoracotomy. Methods: 54 healthy New Zealand white rabbits were randomly divided into two groups: model group (pericardial defect) and HAM group (HAM repair of defect pericardium). The pericardial defect model was made after thoracotomy in 18 rats in the model group and the pericardial defect model in the HAM group in 18 cases. The pericardium was repaired with fresh double-layer HAM after thoracotomy. The pleural cavity was routinely closed after operation. Indwelling thoracic drainage tube. Cardiac function, macroscopical and microscopic evaluation of the degree of cardiac adhesion and fibrosis and myocardial histopathological examination were performed at 30 days and 180 days after operation respectively. Results: (1) Interleukin-10 (Interleukin-10,IL-10), matrix metalloproteinase-9 (matrix metalloproteinase-9,MMP-9), transforming growth factor- 尾 3 (Transforming grow factor- 尾 3- TGF- 尾 3). (2 were expressed in the supernatant of culture medium after HAM culture. The mortality rate of the model group was 15. There was no significant difference between the three groups (P0.05). (3) on the 30th day. There was no significant difference between the three groups of cardiac function indexes LVSP,LVEDP,HR, Max d P/dt and-Min d P/dt (P0.05); on the 60th day, there was no significant difference between the three groups. The Max d P/dt in the control group and HAM group was significantly higher than that in the model group (P0.05). The values of Max d P/dt in control group, HAM group and model group were 4684.61 卤452.03t 4784.30 卤373.61 and 3044.69 卤379.90 Min d P/dt, respectively, which were -3161.58 卤739.91 -3437.87 卤421.84 and -2278.57 卤325.89, respectively. The Max d P/dt and-Min d P/dt in control group and HAM group were higher than those in model group (P0.05). There was no significant difference between the two groups (P0.05). (4) on the 30th day, there was no significant adhesion in the control group, and the macroscopic adhesion score in the HAM group and the model group was mild. There was no significant difference between the two groups (P0.05); on the 60th day, the macroscopic adhesion score of the HAM group was 1.33 卤0.52, which was significantly lower than that of the model group (2.5 卤0.55, P0.05). The macroscopic adhesion scores of model group and HAM group were 0.2.4 卤0.55 and 1.17 卤0.41, respectively. That is, the macroscopic adhesion score of model group was significantly higher than that of HAM group (P0.05). (5) HE staining. The adhesion fibrosis grade was 1-2, the inflammation grade was 0-2, and the adhesion fibrosis grade was 0-1, the inflammation grade was 0-1, the adhesive fibrosis grade was 0-1, the adhesion grade was easy to separate, the HAM was absorbed mostly, and the myocardial cell injury was not obvious in the HAM group. Conclusion: (1) the high expression of IL-10, in the secretion of HAM does not express TGF- 尾 3. (2) the pericardial defect model caused by pericardial frictional wall and air exposure was cut off directly. From 60 to 180 days, obvious adhesion between the heart and surrounding tissues was observed. Furthermore, the ventricular systolic and diastolic properties of the rabbits with progressive cardiac function were decreased. (3) it was found that HAM repair of pericardial defects in New Zealand rabbits had a good effect on preventing and treating adhesion between heart and surrounding tissues and organs. It may be related to the secretion of IL-10 and MMP-9 by HAM.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654
本文编号：2281026
[Abstract]:Objective: to create a better local operation environment for the secondary operation of cardiothoracic surgery. The purpose of this study was to investigate the effect of fresh human amniotic membrane (human amniotic membrane,HAM) on the repair of pericardial membrane after pericardial defect in rabbits and its effect on the adhesion between heart and surrounding tissues on the basis of simulated thoracotomy. Methods: 54 healthy New Zealand white rabbits were randomly divided into two groups: model group (pericardial defect) and HAM group (HAM repair of defect pericardium). The pericardial defect model was made after thoracotomy in 18 rats in the model group and the pericardial defect model in the HAM group in 18 cases. The pericardium was repaired with fresh double-layer HAM after thoracotomy. The pleural cavity was routinely closed after operation. Indwelling thoracic drainage tube. Cardiac function, macroscopical and microscopic evaluation of the degree of cardiac adhesion and fibrosis and myocardial histopathological examination were performed at 30 days and 180 days after operation respectively. Results: (1) Interleukin-10 (Interleukin-10,IL-10), matrix metalloproteinase-9 (matrix metalloproteinase-9,MMP-9), transforming growth factor- 尾 3 (Transforming grow factor- 尾 3- TGF- 尾 3). (2 were expressed in the supernatant of culture medium after HAM culture. The mortality rate of the model group was 15. There was no significant difference between the three groups (P0.05). (3) on the 30th day. There was no significant difference between the three groups of cardiac function indexes LVSP,LVEDP,HR, Max d P/dt and-Min d P/dt (P0.05); on the 60th day, there was no significant difference between the three groups. The Max d P/dt in the control group and HAM group was significantly higher than that in the model group (P0.05). The values of Max d P/dt in control group, HAM group and model group were 4684.61 卤452.03t 4784.30 卤373.61 and 3044.69 卤379.90 Min d P/dt, respectively, which were -3161.58 卤739.91 -3437.87 卤421.84 and -2278.57 卤325.89, respectively. The Max d P/dt and-Min d P/dt in control group and HAM group were higher than those in model group (P0.05). There was no significant difference between the two groups (P0.05). (4) on the 30th day, there was no significant adhesion in the control group, and the macroscopic adhesion score in the HAM group and the model group was mild. There was no significant difference between the two groups (P0.05); on the 60th day, the macroscopic adhesion score of the HAM group was 1.33 卤0.52, which was significantly lower than that of the model group (2.5 卤0.55, P0.05). The macroscopic adhesion scores of model group and HAM group were 0.2.4 卤0.55 and 1.17 卤0.41, respectively. That is, the macroscopic adhesion score of model group was significantly higher than that of HAM group (P0.05). (5) HE staining. The adhesion fibrosis grade was 1-2, the inflammation grade was 0-2, and the adhesion fibrosis grade was 0-1, the inflammation grade was 0-1, the adhesive fibrosis grade was 0-1, the adhesion grade was easy to separate, the HAM was absorbed mostly, and the myocardial cell injury was not obvious in the HAM group. Conclusion: (1) the high expression of IL-10, in the secretion of HAM does not express TGF- 尾 3. (2) the pericardial defect model caused by pericardial frictional wall and air exposure was cut off directly. From 60 to 180 days, obvious adhesion between the heart and surrounding tissues was observed. Furthermore, the ventricular systolic and diastolic properties of the rabbits with progressive cardiac function were decreased. (3) it was found that HAM repair of pericardial defects in New Zealand rabbits had a good effect on preventing and treating adhesion between heart and surrounding tissues and organs. It may be related to the secretion of IL-10 and MMP-9 by HAM.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654
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