壳聚糖透明质酸复合物止血粉在鼻腔止血应用的可行性研究

发布时间：2018-05-10 06:54

本文选题：壳聚糖透明质酸复合 + 阿里斯泰可　；参考：《暨南大学》2010年硕士论文

【摘要】： 目的： 1.探讨壳聚糖透明质酸复合止血粉及阿里斯泰可(Arista)对正常鼻粘膜影响。 2.探讨壳聚糖透明质酸复合止血粉在内镜鼻窦手术(endoscopic sinus surgery,ESS)术后止血效果及临床应用的可行性。方法：将24只新西兰白兔分成三组,第一组8只,鼻腔未作创面,实验组及对照组各4只,实验组予壳聚糖透明质酸复合(chitosan-hyaluronic acid composite)止血粉,对照组予Arista止血粉喷颌鼻甲,第3天取颌鼻甲粘膜行光镜及扫描电镜观察；第二组8只,实验组及对照组各4只,均予颌鼻甲造创面,实验组予喷壳聚糖透明质酸复合止血粉,对照组予Merocel填塞,第3天处死全部白兔取颌鼻甲粘膜行光镜及扫描电镜观察；第三组8只,双侧颌鼻甲造创面后,随机选择一侧鼻腔使用壳聚糖透明质酸复合止血粉,对侧使用Arista止血粉。并立即鼻孔棉条填塞,计算失血量。第3天、7天及第14天内窥镜下观察材料降解情况并评分。第7天,第14天各处死4只白兔时取鼻腔分泌物行细菌培养及颌鼻甲粘膜行光镜观察。结果：第一组,光镜及扫描电镜下实验组及对照组粘膜与正常粘膜无明显区别；第二组,实验组光镜下,粘膜轻度充血、水肿,炎症细胞少许侵润；扫描电镜下粘膜未见异常；对照组光镜下,粘膜充血、水肿,炎症细胞侵润,电镜下纤毛倒伏,有明显压迫痕迹。第三分组,C.H.complex及Arista止血效果差别无统计学意义(P＞0.05)；3及7天的材料降解分析C.H.complex降解速度均比Arista慢.(P＜0.05),7天、14天光镜下实验组炎症反应较Arista重。细菌培养提示,在第7天,C.H.complex细菌生长数量及菌种比Arista旺盛,第14天两组细菌生长数量及菌种趋近相同。结论： 1、壳聚糖透明质酸复合止血粉及Arista对正常鼻粘膜无负面影响；2、Merocel对粘膜有较明显的负面影响；3、壳聚糖透明质酸复合止血粉止血效果与Arista相当；4、壳聚糖透明质酸复合止血粉降解速度慢,可引起粘膜炎症反应；5、壳聚糖有可能成一种新的鼻腔非填塞可降解止血材料。
[Abstract]:Objective: 1. To investigate the effects of chitosan hyaluronic acid compound hemostatic powder and Arista on normal nasal mucosa. 2. To investigate the hemostatic effect and clinical application of chitosan hyaluronic acid combined with hemostatic powder in endoscopic sinus surgeryen (ESS). Methods: 24 New Zealand white rabbits were divided into three groups: the first group (n = 8) had no nasal wound, the experimental group (n = 4) and the control group (n = 4) were treated with chitosan hyaluronic acid compositeite. The control group was treated with Arista hemostatic powder. On the 3rd day, the mucosa of the mandibular turbinate was observed by light microscope and scanning electron microscope, the second group (n = 8), the experimental group (n = 4) and the control group (n = 4) were treated with maxillary turbinostomy, the experimental group were treated with chitosan hyaluronic acid compound hemostatic powder, the control group was filled with Merocel. On the 3rd day, all the rabbits were killed for light microscope and scanning electron microscope observation, and 8 rabbits in the third group were randomly selected to use chitosan hyaluronic acid compound hemostatic powder and Arista hemostatic powder in one side of nasal cavity after bilateral maxillary turbinostomy. And immediately the nostril cotton stuffing to calculate the amount of blood loss. The degradation of the material was observed under endoscope on day 3 and day 14. On the 7th and 14th day, the nasal secretion was taken from 4 rabbits and the mucous membrane of maxillary turbinate was observed under light microscope. Results: In the first group, there was no significant difference between the mucous membrane of the experimental group and the control group under light microscope and scanning electron microscope, while in the second group, there was mild congestion, edema and a little infiltration of inflammatory cells under the light microscope in the experimental group, and no abnormal mucous membrane was found under the scanning electron microscope. In the control group, hyperemia, edema and infiltration of inflammatory cells were observed under light microscope. There was no significant difference in hemostatic effect between C. H. complex and Arista in the third group. The degradation rate of C.H.complex was slower than that of Arista on day 3 and day 7. The inflammatory reaction of experimental group was more serious than that of Arista under light microscope for 14 days under light microscope. The results showed that the number and species of C. H. complex bacteria were stronger than that of Arista on the 7th day, and the growth numbers and strains of the two groups were the same on the 14th day. Conclusion: 1. Chitosan hyaluronic acid compound hemostatic powder and Arista had no negative effect on normal nasal mucosa. The chitosan hyaluronic acid compound hemostatic powder had the same hemostatic effect as Arista and chitosan hyaluronic acid compound. The rate of degradation of hemostatic powder is slow, Chitosan may become a new non-tamponade biodegradable hemostatic material.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R765

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