生肌通窍止血海绵止血作用的实验研究及临床疗效观察

发布时间：2018-01-04 02:00

本文关键词：生肌通窍止血海绵止血作用的实验研究及临床疗效观察　出处：《安徽中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:(1)验证生肌通窍止血海绵对鼻内镜手术术后术腔止血及促进术腔黏膜修复作用;(2)探讨生肌通窍止血海绵止血及术腔黏膜修复的可能机制;(3)求证中医药在鼻窦炎鼻内镜术后术腔止血以及促进黏膜修复中应用的可能性。方法:(1)取30只家兔入组,随机分为正常对照组、对照组I和治疗组I,分别在家兔背部两侧对称处做切口,切断筋膜上血管,待血液自然流出后开始计时,正常对照组不予以干预、治疗组I和对照组I分别立即将生肌通窍止血海绵、膨胀海绵分别置于切口出血处,每隔15s用滤纸吸去血滴1次,直至血液自然停止,整个过程用摄像仪记录出血情况,并运用视频分析软件计算出血时间;(2)取20只家兔入组,随机分为治疗组II和对照组II,分别在家兔背部两侧对称处做切口,分别将生肌通窍止血海绵、膨胀海绵置于两组家兔背部切口内,缝合切口,48小时后打开切口,取出填塞物,观察切口内情况,并取填塞物周围组织行HE染色检测;(3)取20只家兔入组,随机分为治疗组III和对照组III,分别从鼻背切口打开家兔鼻窦,分别将生肌通窍止血海绵、膨胀海绵置于鼻窦内,缝合切口,48小时后打开切口,取出填塞物,观察窦内情况,并取窦腔黏膜行HE染色检测;(4)符合诊断标准并具手术指征的60例慢性鼻-鼻窦炎病例选择入组,随机划分为治疗组IV和对照组IV,两组均常规行鼻内镜鼻窦开放术,治疗组IV和对照组IV术后术腔分别予以生肌通窍止血海绵和膨胀海绵填塞,术后48小时取出填塞物。围手术期其他治疗两组均相同。记录患者出血量及疼痛情况。并于填塞前后切取窦腔黏膜,行HE及免疫组化染色,同时抽取患者血液检测血清IL-1、IL-4水平;(5)将上述观察资料数据化处理后,采用统计学分析,得出相应结论。结果:通过动物实验,发现三组家兔出血时间,差异有统计学意义(P0.05)。治疗组I与对照组I出血时间明显低于正常对照组;肉眼观察下,治疗组II局部干燥,无明显红肿及渗出,对照组II局部有大量血水样液体潴留,稍肿,膨胀海绵与周围组织粘连明显;填塞物周围的组织HE染色切片提示,治疗组II较对照组II术腔肌肉炎症反应轻微;鼻窦黏膜HE染色切片提示,治疗组III较对照组III术腔黏膜出血少,炎症反应轻微。通过临床实验,发现两组患者术后疼痛VAS评分无显著性差异(P0.05);术后48小时内出血量,差异有统计学意义(P0.05),治疗组IV出血量明显低于对照组IV;鼻窦黏膜HE染色切片提示,治疗组IV较对照组IV术腔黏膜炎症反应轻微;鼻窦黏膜免疫组化染色切片提示,治疗组IV在鼻窦黏膜上IL-1和IL-4的表达均低于治疗组IV;两组患者术后48小时外周血中炎症因子(IL-1、IL-4)水平,差异有统计学意义(P0.05),治疗组IV炎症因子水平明显低于对照组IV。结论:(1)通过动物实验,生肌通窍止血海绵局部止血作用明显,并且有良好的组织相容性;(2)通过临床研究,同样证明了生肌通窍止血海绵对鼻窦炎内镜术后具有良好的止血作用,并能调节鼻窦黏膜IL-1和IL-4的表达,对鼻窦炎患者血清IL-1和IL-4的表达也有调节作用,提示具有抗炎抑炎作用。(3)据此可以推断生肌通窍止血海绵通过局部止血、调节炎症因子的表达促进鼻-鼻窦黏膜术后的修复,值得进一步研究和推广。
[Abstract]:Objective: (1) to verify the myogenic Tongqiao hemostatic sponge on nasal endoscopic surgery postoperative cavity hemostasis and promoting effects in the repair of nasal cavity mucosa; (2) to explore the possible mechanism of myogenic Tongqiao hemostatic sponge hemostatic and nasal cavity mucosa repair; (3) confirmation of Chinese medicine in the nasal cavity and promote hemostasis the possibility of application in mucosal repair. Methods: (1) 30 rabbits were randomly divided into normal control group, control group I and group I, respectively incision in the back of rabbit bilateral symmetry, cut off the fascia to the natural flow of blood vessels, after the beginning of time, the normal control group did not intervene. The treatment group I and control group I were immediately Shengji Tongqiao hemostatic sponge, expansive sponge were placed in the incision bleeding, blood sucking to 1 by filter every 15s, until the blood natural stop, the whole process with the camera to record the bleeding, and the use of video analysis software The bleeding time; (2) 20 rabbits were randomly divided into treatment group and control group were II II, incision on the back of rabbit bilateral symmetry, respectively, myogenic Tongqiao hemostatic sponge, sponge in expansion of two groups of rabbits back incision, suture of incision, incision open after 48 hours, remove the stuffing observe, incision, and packing of surrounding tissue by HE staining detection; (3) 20 rabbits were randomly divided into treatment group and control group were III III, open the rabbit sinus from the nasal dorsal incision, respectively Shengji Tongqiao hemostatic sponge, sponge in sinus expansion, sutured. Cut open after 48 hours, remove the stuffing, observe the sinus and sinus mucosa HE staining; (4) met the diagnostic criteria and surgical indications of 60 cases of chronic sinusitis were selected into the group, were randomly divided into treatment group and control group IV IV, the two groups were routine nasal endoscope Endoscopic sinus surgery, the treatment group IV and control group IV after surgery respectively Shengji Tongqiao cavity hemostatic sponge and swelling sponge packing, after 48 hours out wadding. Perioperative treatment of the two groups were the same. Record the amount of bleeding and pain. And the sinus mucous membrane in packing before and after HE and immunohistochemical staining, detection of serum IL-1 and IL-4 levels in patients with blood extraction; (5) the observation data processing, statistical analysis, draw the corresponding conclusion. Results: through animal experiment, three rabbits bleeding time, the difference was statistically significant (P0.05) and I treatment group. The control group I the bleeding time was significantly lower than normal control group; visual observation, the treatment group II partial dry, no obvious swelling and exudation, the control group II has a large number of local blood samples and fluid retention, slightly swollen, expansive sponge adhesion with surrounding tissue significantly; packing material around Tissue HE staining indicated that the treatment group than the control group II II cavity muscle slight inflammation; sinus mucosa HE staining indicated that the treatment group than the control group III III nasal cavity mucosa bleeding, slight inflammatory reaction. Through clinical trials, found that two groups of patients with postoperative pain VAS scores had no significant difference (P0.05); the amount of bleeding within 48 hours after the surgery, the difference was statistically significant (P0.05), IV treatment group the amount of bleeding was significantly lower than the control group IV; sinus mucosa HE staining indicated that the treatment group than the control group IV IV of mucosa mild inflammatory reaction; sinus mucosa immunohistochemical staining indicated that the expression of IV IL-1 in the treatment group sinus mucosa and IL-4 in treatment group were lower than IV; 48 hours after operation in the two groups in the peripheral blood inflammatory factors (IL-1, IL-4) level, the difference was statistically significant (P0.05), treatment group IV inflammatory factor level was significantly lower than the control group IV. conclusion: (1) through animal The myogenic Tongqiao hemostatic sponge local hemostatic effect is obvious, and has good biocompatibility; (2) through clinical research, also proved that the myogenic Tongqiao hemostatic sponge has good hemostasis for sinusitis after endoscopic surgery, and can regulate the expression of IL-1 and IL-4 in sinus mucosa, the expression of IL-1 and IL-4 in serum of patients with sinusitis also has a regulatory role, suggesting that the anti-inflammatory anti inflammation effect. (3) we can deduce that the myogenic Tongqiao hemostatic sponge through local hemostasis, regulate the expression of inflammatory cytokines promote the repair of nasal sinus mucosa after operation, it is worthy of further research and promotion.

【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R276.1

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