维拉帕米—硝酸甘油保存液对兔静脉的保护作用

发布时间：2018-01-06 05:35

本文关键词：维拉帕米—硝酸甘油保存液对兔静脉的保护作用　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:冠心病从20世纪初开始在工业化国家流行,至今仍是当今社会发达国家以及发展中国家普通人群发病率和死亡率的主要原因之一,是危害人类健康的“第一杀手”。为此,人类对于冠心病治疗方法的研究也从未止步。1962年Sabiston进行了世界上首例冠状动脉旁路移植术(CABG),距今已有半个世纪的历史。尽管当今介入疗法深受追捧,但冠脉旁路移植术在冠心病的治疗中仍然享有不可替代的地位。大隐静脉(GSV)因其便于取材、长度足够、对人体影响较小而成为CABG中最主要的血管移植材料。但是大隐静脉桥术后15年通畅率只有50%,这极大的影响了冠心病人术后生活质量及生命安全。基于临床实践经验,从大隐静脉离体到搭完最后一根桥(通常1个病人需要搭3-4根桥),静脉至少需要处于离体状态30-60分钟,而这一段时间的静脉保护就只能依靠适当的保存液。研究发现这一环节的保护是否有效对于CABG的近期及远期通畅率有着重要的影响。GV液是维拉帕米和硝酸甘油的混合溶液,1993年Guo-Wei He等将这两种药物共同用于大隐静脉的保护,取得了不错的效果。近年来大量的研究显示了GV液的功效,同时它简单易配,价格低廉,可能是一种很理想的静脉保护液。本实验设计以兔颈外静脉倒置端侧吻合于同侧颈动脉为动物模型,旨在研究GV液对静脉的近期及远期保护作用,作为进一步研究的参考,为GV液用于临床提供实验依据。方法:成年新西兰大耳兔30只,雌雄不限,体重在2.5-3.0kg之间。随机分为3组,分别为A.空白对照组,B.罂粟碱生理盐水对照组,C.GV液实验组。取下一侧颈外静脉,室温下于对应的保存液中保存30分钟,然后将静脉分为两段,一段用于形态学观察(HE染色后计算内皮细胞覆盖率和透射电镜下观察内膜保护情况),另一段上下倒置吻合于同侧颈动脉上。收集保存过标本的保存液以Elisa法测ET-1含量。2周后取下桥血管,做HE染色观察内膜增厚情况,计算内膜比中膜厚度比值即I/M。所得数据以SPSS13.0统计软件进行统计分析。计量数据用均数±标准差描述,各组数据分别进行正态性检验和方差齐性检验。如果数据符合正态方差齐的条件,就可以使用完全随机设计两均数比较的t检验来分别检验两组均数有无差异。若正态但方差不齐,可以用对自由度进行校正后的t′检验比较两组均数差异。如果非正态方差不齐,使用非参数检验。以P0.05为标准,认为差别具有统计学意义。结果:在近期保护实验中,空白组内皮细胞覆盖率得分1.556±0.416,对照组1.850±0.264,实验组2.550±0.430。GV液组内皮细胞覆盖率明显高于前两组,差别有统计学意义(P0.05),而罂粟碱生理盐水对内皮破坏较大,与空白组差异不大,差别无统计学意义(P0.05)。从电镜下可见实验组内皮细胞与基膜连接较完整,胞间连接紧密,细胞器功能保存较好。而罂粟碱组及空白组内皮细胞脱落严重,胞质水肿,细胞间紧密连接打开,线粒体空泡化,嵴融合。Elisa的结果:A组:152.172±14.427 ng/L,B组:144.880±10.149 ng/L,C组:61.032±10.849 ng/L,GV液中ET-1释放量明显低于空白组及对照组,差别有统计学意义(P0.05)。2周后测量桥血管I/M值,A组:1.469±0.159,B组:1.478±0.160,C组:0.539±0.123,GV液组内膜增厚最轻,与其他两组比较差异有统计学意义(P0.05)。结论:在兔静脉保护实验中,GV液在保护内膜、抑制内皮素及抑制血管桥再狭窄方面均优于罂粟碱生理盐水和肝素盐水。罂粟碱生理盐水与肝素生理盐水在内膜保护、抑制内皮素释放、预防狭窄方面没有明显差异。
[Abstract]:Objective: coronary heart disease from the beginning of twentieth Century in the industrialized countries, is still in today's society in the developed countries and the main cause of morbidity and mortality in developing countries is one of the common people, harm to human health "the first killer". Therefore, human studies for coronary heart disease treatment has never stopped.1962 Sabiston performed the first coronary artery bypass grafting (CABG), which has a history of half a century. Despite the intervention sought after, but coronary artery bypass grafting in the treatment of coronary heart disease still enjoys irreplaceable position. The great saphenous vein (GSV) materials, because of its easy enough length, less effect to human body and has become the most important vessel graft material in CABG. But the great saphenous vein after 15 year patency rate was only 50%, which has a great influence on patients with coronary heart disease postoperative quality of life and life safety based on. Clinical experience, from the great saphenous vein in vitro to take the last one bridge (usually 1 patients need a 3-4 root bridge), at least in vitro vein and vein protection for 30-60 minutes, this time can only rely on the appropriate preservation solution. The study found that the protection of this link is valid for CABG of the short-term and long-term patency rate has important effect of.GV liquid is a mixture of Vera Pammy and nitroglycerin, 1993 Guo-Wei He of the two kinds of common drugs for the protection of great saphenous vein, and achieved good results. In recent years a large number of studies show that the GV effect of fluid, and it is easy to match the price. Low, may be an ideal intravenous protection liquid. The experimental design to the external jugular vein inverted end to side anastomosis in the ipsilateral carotid artery as the animal model to study GV solution on the vein of the short-term and long-term protective effect, as in a Step on the reference, to provide experimental basis for clinical GV solution for adult. Methods: 30 New Zealand rabbits, male or female, weighing between 2.5-3.0kg were randomly divided into 3 groups, respectively A. blank control group, B. papaverine saline control group, experimental group C.GV solution. Remove the external jugular vein at room temperature, preservation solution corresponding to the stored in 30 minutes, and then the vein is divided into two sections, one section for morphological observation (HE staining after calculation of endothelial cell coverage and transmission electron microscope observation of endometrial protection), the other section of the inverted anastomosis in the ipsilateral carotid artery. Save to save fluid specimens under the bridge were taken using Elisa method to measure the content of ET-1 after.2 weeks, HE staining was used to observe the intimal thickening, the intimal medial thickness ratio than that of the I/M. data with SPSS13.0 statistical software for statistical analysis. Measurement data with the standard deviation of each data description. Are test of normality and homogeneity of variance test. If the data accord with normal variance conditions, you can use a completely randomized design two average t test compared to test two groups have no difference. But if the normal variance not neat, can be used for inspection after correction of T 'the degrees of freedom were compared between the two groups. If the non normal variance not neat, using non parametric test. Based on the standard of P0.05, was considered statistically significant. Results: in the near future protection experiment, blank group endothelial cell coverage score 1.556 + 0.416, 1.850 + 0.264 in the control group, the experimental group was 2.550 + 0.430.GV group of endothelial cell coverage rate was significantly higher than that of the former two groups, the difference was statistically significant (P0.05), and papaverine saline on endothelial damage, with little difference in blank group, no significant difference (P0.05). From the experimental group under electron microscope in skin cells and medium The film is connected with complete intercellular tight junction, cell function is well preserved. The papaverine group and blank group endothelial cell loss serious, cytoplasmic edema, intercellular tight junctions on mitochondrial vacuolization, cristae fusion.Elisa results: A group: 152.172 + 14.427 ng/L, group B: 144.880 + 10.149 ng/L, C group: 61.032 + 10.849 ng/L, GV was the release of ET-1 was significantly lower than the blank group and the control group, the difference was statistically significant (P0.05).2 weeks after the measurement of vascular bridge I/M, A group: 1.469 + 0.159, 1.478 + 0.160, B group: C group: 0.539 + 0.123 GV, liquid membrane thickening group the light, and there was significant difference between two groups (P0.05). Conclusion: in the experimental rabbit vein protection, GV protection fluid in the intima, inhibition of endothelin and inhibition of restenosis were better than papaverine saline and heparin saline. Papaverine saline and heparin saline in endometrial protection, inhibit There was no significant difference between the release of skin hormone and the prevention of stenosis.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R543.6

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