利用动态肺顺应性设定呼气末正压在胸腔镜肺叶切除术中的运用

目的 探讨单肺通气利用动态肺顺应性设定呼气末正压通气(positive end-expiratory pressure,PEEP)的优势及可行性. 方法 选择预行右侧肺叶切除患者80例,完全随机分为A组和B组,每组40例:A组,单肺通气实施肺膨胀(sustained inflation,SI)复张后加用20 cmH2O(1 cmH2O=0.098 kPa)的PEEP并递减滴定,随后以得到最大肺顺应性的PEEP值通气,直到恢复双肺通气;B组,通气PEEP值固定为5 cmH2O,其他通气方法同A组.记录患者血气、呼吸等参数. 结果 两组设定的PEEP值[A组(9.2±1.2) cmH2O,B组5 cmH2O]差异有统计学意义(P＜0.05);在单肺通气1 h(T3)、手术结束(T4)时,两组动脉血氧分压(partial pressure of oxygen,PaO2)比较,差异有统计学意义(P＜0.05);B组的PaO2在T3～T4逐步降低,差异有统计学意义(P＜0.05),而A组则维持较好(P＞0.05);T3、T4时刻A组的动态肺顺应性[(30.8±5.9)、(30.7±6.4) ml/cmH2O]与B组[(26.6±5.5)、(26.4±5.2) ml/cmH2O]比较,差异有统计学意义(P＜0.05). 结论 胸腔镜肺叶切除术中的单肺通气,利用动态肺顺应性设定的PEEP值通气能够得到更好的氧合及呼吸参数,并且维持较好.     

不同能量器械分离肺段间交界面的离体实验研究

目的:对比研究电刀和超声刀两种能量器械在肺段切除术中分离段间交界面效果的差异。方法:建立离体猪肺的肺段切除术模型,使用两种能量器械分别行段间交界面的分离,比较两组肺段切除术模型的漏气、切缘损伤等指标。结果:使用电刀和超声刀分割后,段间交界面的漏气程度无明显差异[(17.3±1.0)cmH 2O对(16.4±...     

纤维蛋白胶载神经生长因子促进周围神经再生的研究

目的　探讨纤维蛋白胶 (FG)作为神经生长因子 (NGF)载体对周围神经再生的促进作用。方法　将Wistar大鼠 96只随机分为 4组 ,即对照组、FG组、NGF组、FG +NGF组 ,每组 2 4只 ,以大鼠左侧坐骨神经为修复神经模型进行实验。术后 2、4、8周进行组织学检查 ,术后 8周进行电生理检查、肌湿重检测、图像分析和透射电镜观察。结果　FG +NGF组的神经传导速度、肌张力、肌湿重、有髓纤维截面积恢复率分别为 ( 84.10± 2 .33) %、( 83 .88± 2 .96 ) %、( 6 2 .5 4± 5 .94) %、( 71.0 1± 3 .6 2 ) % ,吻合口有髓纤维通过率为 ( 6 5 .5 1± 4.5 4) % ,高于对照组、FG组 ( P <0 .0 1) ,高于NGF组 (P <0 .0 5 ) ,FG +NGF组大鼠坐骨神经再生优于单纯NGF组。结论　纤维蛋白胶可作为NGF的载体 ,用纤维蛋白胶载NGF修复周围神经损伤 ,有促进周围神经再生的作用。     

椎体内注射医用生物蛋白胶对松质骨创面出血影响的实验研究

目的:探讨椎体内注射医用生物蛋白胶减少松质骨创面出血的有效性与安全性.方法:10只成年家犬全麻下前路暴露L2～15椎体,其中6只动物L2～L5椎体随机分为实验组与对照组,每组每只2个椎体.实验组椎体内注射医用生物蛋白胶,对照组未注射给药.给药30s后同时于L2～L5椎体前方作直径8mm、深6mm的骨缺损,记录骨创面的控制出血时间、止血时间、出血量及各组10min内止血百分比.另4只动物L2～L5椎体内注入医用生物蛋白胶与欧乃派克混合物.给药30min后行CT扫描计算椎体内药物扩散体积百分比,观察药物局部渗漏及静脉渗漏情况.所有动物实验前后检测血浆凝血酶原时间(PT),术后3d拍胸部X线片后处死,剖胸探查有无肺梗死灶.结果:实验组和对照组的控制出血时间分别为97±48s和417±101s(P<0.001),止血时间分别为291±167s和890±237s(P<0.001),出血量分别为0.80±0.67g和4.39±1.84g(P<0.001),10min 内止血百分比分别为91.67%和16.67%(P=0.001).药物扩散体积百分比为72.1%±11.2%.药物造影组CT扫捕未发现静脉渗漏,椎间孔渗漏1个(6.25%),椎管内渗漏5个(31.25%).所有动物实验前、后PT转异率无显著性差异(P=0.628).所有动物术后未发现神经损伤症状,胸片未见肺梗死征象,剖胸探查末发现肺梗死灶.结论:成年家犬椎体内注射医用生物蛋白胶可明显减少松质骨创面出血,安全性较好.     

负压封闭引流技术治疗压疮的实验研究

目的通过负压封闭引流技术治疗压疮的动物实验研究,探索治疗压疮的有效方法。方法将雄性新西兰兔建立压疮模型后随机分为4组(每组12只):对照组创面涂抹蛋清,单纯负压组单纯使用负压封闭材料覆盖,钻孔负压组使用负压封闭材料覆盖结合骨组织钻孔,生长因子组使用负压封闭材料覆盖结合成纤维细胞生长因子,每周更换负压封闭材料进行创面观察(肉芽组织情况,创面表面积,切取创面组织行切片HE染色)。结果除对照组创面于5周愈合外,其余3组均于4周愈合。第1周创面表面积钻孔负压组及单纯负压组大于对照组(P0.05);单纯负压组、钻孔负压组、生长因子组于第1、2、3周HE染色纤维细胞密度均大于对照组(P0.05)。结论负压封闭引流技术治愈压疮切实有效,早期结合使用促软组织生长方法可加强疗效。     

肺复张策略对健侧肺氧合及顺应性的影响

目的 评价肺复张策略(lung recruitment maneuvers,LRM)对健侧肺氧合及顺应性的影响. 方法 ASA分级Ⅱ级择期行胸腔镜辅助下肺切除术患者40例,采用随机数字表法分为对照组(C组)和实验组(L组),每组20例.C组术中常规单肺通气(one lung ventilation,OLV),L组OLV 20 min后进行1次LRM,两组均在OLV结束关闭胸腔前进行1次肺复张.分别于患者麻醉前(T0),OLV后20 min(T1),LRM后15 min(T2)、30 min(T3)、45 min(T4)及OLV结束(T5)时,采集患者生命体征数据并采集动脉血样本进行血气分析,根据公式计算肺顺应性(dynamic compliance,Cdyn). 结果 与C组相比,L组PaO2在T2[(150±11) mmHg比(204±21) mmHg,1 mmHg=0.133 kPa]、T3[(154±12) mmHg比(176±14) mmHg]、T5[(442±20) mmHg比(473±15) mmHg]时点均升高(P＜0.05),Cdyn在T2[(21±3) ml/cmH2O比(25±3) ml/cmH2O,1 cmH2O=0.098 kPa]和T5[(26±3) ml/cmH2O比(31±5)ml/cmH2O)]时点提高(P＜0.05). 结论 LRM可以有效改善OLV期间氧合及Cdyn,单次LRM提高PaO2有效时间为30 min,在15 min左右PaO2改善最为明显.     

高压氧对兔耳创面模型早期瘢痕组织形成的影响

目的 通过观察高压氧对兔耳创面愈合及瘢痕形成的影响,以探讨在临床中应用高压氧防治早期瘢痕的可行性.方法 选取新西兰白兔16只建立兔耳增生性瘢痕模型,每只兔左耳4个创面,右耳4个创面,共128个,随机分为高压氧组与对照组2组,每组8只,64个创面.高压氧组术后立即开始高压氧处理,2个大气压,吸氧60 min,每日1次,疗程以创面愈合为准.期间观察记录创面愈合情况以及兔耳瘢痕大小、厚度、颜色、硬度.待创面全部愈合后,切取创面进行HE染色,Masson染色和苦味酸天狼星红染色,行病理学观察、检测及分析.结果 高压氧组愈合时间为(16.7±1.8)d;对照组为(20.2±2.3)d,差异有统计学意义(P＜0.05).高压氧组瘢痕增生发生率较对照组低,实验组发生率为(38/64,59.4％),对照组发生率为(52/64,81.2％),差异有统计学意义(P＜0.05).光镜下观察,高压氧组真皮层较对照组薄,成纤维细胞数量较少,胶原较疏松,排列较整齐,胶原结节和漩涡状结构少.瘢痕增生指数,高压氧组为3.48±0.94,对照组为4.65 ±0.76,差异有统计学意义(P＜0.01).成纤维细胞密度,高压氧组为186.5±27.3,对照组为246±41.6,差异有统计学意义(P＜0.05).胶原纤维面密度,高压氧组为(31.42±5.36)％,对照组为(43.62±7.36)％,差异有统计学意义(P＜0.05).Ⅰ型和Ⅲ型胶原含量,高压氧组分别为(71.42±5.36)％和(28.58±5.36)％,对照组为(62.46±7.32)％和(37.54±7.32)％,差异有统计学意义(P＜0.05).Ⅰ型和Ⅲ型胶原比例,高压氧组为2.499,对照组为1.664,高压氧组比例更为接近正常皮肤Ⅰ型和Ⅲ型胶原约4∶1的比例.结论 高压氧可促进创面愈合,并对兔耳早期增生性瘢痕有较明显的抑制作用.     

蘸胶粘接法与针线法吻合细小血管的比较研究

目的探讨吻合细小血管更理想、安全、快捷的方法。方法大白鼠40只,左侧股动脉后壁和前壁正中各缝合1针作为定点牵引,蘸胶粘接法端-端吻合为实验组,右侧股动脉行常规针线法端-端吻合为对照组,取2只动物两侧股动脉做吻合口耐压实验,其余动物分别于术后1周、2周、3周、4周取血管标本,采用光学显微镜和扫描电镜观察吻合口部愈合情况。结果两侧血管全部吻合通畅,粘接法用时(12±2min)比针线法(18±3min)缩短1/3,粘接法吻合口耐压(300mmHg)优于针线组,吻合口电镜观察粘接法内膜更为平整、光滑。结论定点缝线牵引蘸胶粘接法端-端吻合显微细小血管快速、安全、效果可靠,具有较好临床应用前景。     

雄性兔低顺应性膀胱模型的建立

目的 探讨通过膀胱出口部分梗阻建立低顺应性膀胱模型的方法.方法 将成年雄性新西兰兔20只随机分为2组:对照组10只于实验开始时行尿动力学检测;梗阻组10只应用膀胱颈部分结扎的方法,造成膀胱出口部分梗阻,分别于8、12、14周进行尿动力检查,观察膀胱顺应性和膀胱重量的变化.结果　膀胱重量:梗阻14周组(14.1±2.3)g显著高于对照组(2.7±0.5)g(P＜0.01);膀胱顺应性:梗阻14周膀胱顺应性(1.21±0.44)ml/cmH2O显著低于对照组(2.68±0.67)ml/cm H2O(P＜0.01).结论　结扎法致膀胱出口部分梗阻是建立低顺应性膀胱模型的可靠方法.

Abstract：

Objective To investigate the approaches of establishing the model of low compliance bladder by partial bladder outlet obstruction. Methods Twenty adult male New Zealand rabbits were randomly divided into 2 groups (n = 10 each group). In control group the rabbits were given urodynamic examination at the beginning. In obstruction group, the bladder neck of 10 adult male New Zealand rabbits was partially ligated. Eight, 12 and 14 weeks later, urodynamic examinations were carried out to observe the changes of bladder compliance. Results The bladder weight was increased significantly in obstruction group at 14th week ( 14. 1 ±2. 3) g as compared with that in control group (2. 7 ±0. 5) g,P ＜0. 01. The compliance in obstruction group at 14th week (1.21 ± 0. 44) ml/cm H2O was less than in control group (2. 68 ± 0. 67) ml/cm H2O,P ＜ 0. 01. Conclusion Bladder neck ligation-induced bladder partial outlet obstruction is a reliable method to build the model of low compliance bladder.     

自体脂肪干细胞基质胶对兔耳全层皮肤缺损创面愈合及瘢痕增生的影响

目的探讨自体脂肪干细胞基质胶对兔耳全层皮肤缺损创面愈合及瘢痕增生的影响, 并分析其相关机制。方法采用实验研究方法。切取42只2～3个月龄雄性新西兰大白兔背部完整脂肪垫, 制备脂肪干细胞基质胶, 并于每只兔双耳腹侧制备全层皮肤缺损创面, 将左耳创面纳入脂肪干细胞基质胶组(以下简称基质胶组)、右耳创面纳入磷酸盐缓冲液(PBS)组, 分别注入自体脂肪干细胞基质胶和PBS。计算伤后7、14、21 d创面愈合率, 并于创面愈合后1、2、3、4个月行创面形成瘢痕组织(以下简称瘢痕组织)温哥华瘢痕量表(VSS)评分;行苏木精-伊红染色观测伤后7、14、21 d创面组织病理学改变和创面愈合后1、2、3、4个月瘢痕组织真皮厚度;行Masson染色观察伤后7、14、21 d创面组织和创面愈合后1、2、3、4个月瘢痕组织中胶原排布, 并计算胶原容积分数(CVF);采用免疫组织化学法观测伤后7、14、21 d创面组织中微血管计数(MVC)与创面愈合后1、2、3、4个月瘢痕组织中转化生长因子-β1(TGF-β1)和α平滑肌肌动蛋白(α-SMA)的表达, 并行基质胶组瘢痕组织中α-SMA与TGF-β1表达相关性分...     

Gelatin-resorcinol-formaldehyde-glutaraldehyde glue for sealing pulmonary air leaks during thoracoscopic operation

BACKGROUND: Intraoperative pulmonary air leakage is one of the most troublesome complications in video-assisted thoracoscopic surgical procedures. We developed a sealing procedure using gelatin-resorcinol-formaldehyde-glutaraldehyde (GRFG) glue for pulmonary air leaks during such operations. METHODS: Formaldehyde-glutaraldehyde (FG) jelly is prepared by mixing FG fluid with 2.5% sodium carboxymethyl cellulose to make the FG fluid viscous. We performed an adhesion-strength test to determine the optimum ratio of gelatin-resorcinol mixture to FG jelly and then conducted an air leakage test on swine lung to compare the sealing effect between fibrin and GRFG glues. To study the histotoxicity of the GRFG glue, the sealant was applied to injured rabbit lung, and the rabbits were followed for 1 day to 188 days. For clinical studies, we developed an endosyringe to apply the GRFG glue on the target site during video-assisted thoracoscopic surgical procedures and used this technique in 21 patients with intraoperative air leaks. In addition, the side effects of GRFG glue application were studied in 52 patients in whom glue was used in several ways during lung operations. RESULTS: The results of the adhesion-strength test favored a 2:1 gelatin-resorcinol to FG ratio. The mean pressure required to produce air leakage was significantly higher with GRFG glue than with fibrin glue (p<0.001). No critical histologic damage was seen in the rabbit lung, and the glue persisted on the lung surface for 188 days after sealing. Clinical application of the glue in 21 patients resulted in complete stoppage of air leakage during operation and long afterward, except in 1 patient with a late-onset lung fistula. The FG jelly helped prevent glue spillage at the target site, regardless of angle. A transient rise in temperature up to 38.60C was observed as a side effect 7 days after operation in 5 (9.6%) of the 52 patients. CONCLUSIONS: A GRFG glue using FG jelly seals pulmonary air leaks effectively, simply, and safely during video-assisted thoracoscopic surgical procedures.     

医用生物蛋白胶在腮腺浅叶良性肿瘤切除术中的应用研究

目的:探讨医用生物蛋白胶在腮腺浅叶良性肿瘤切除术中的临床应用。方法:2006年1月~2011年6月来我院口腔颌面外科住院手术治疗的腮腺浅叶良性肿瘤患者50例,随机分为医用生物蛋白胶组(n=24)和对照组(n=26),术后从术区引流量、拔管时间、术区有无感染、面瘫、涎瘘及Frey综合征进行观察和评价。结果:两组患者均未发生切口感染,与对照组比较,医用蛋白胶组患者术后第1天和术后总引流量均明显减少,拔管时间提前,差异有统计学意义(P0.05)。医用蛋白胶组发生术后并发症的例数明显少于对照组(P0.05)。结论:在腮腺浅叶良性肿瘤切除术中应用医用生物蛋白胶可明显减少术后并发症的发生,并在一定程度上促进术后创口的愈合。     

Efficacy of a Pedicled Pericardial Fat Pad Fixed with Fibrin Glue on Postoperative Alveolar Air Leakage

The purpose of this randomized trail was to investigate the effect of using a pedicled pericardial fat pad fixed with fibrin glue on postoperative alveolar air leakage. Thirty consecutive patients with lung cancer, who had moderate alveolar air leaks after pulmonary resection, were randomized into two groups: in group A fibrin glue was applied onto the surface of the leaking raw lung and in group B, after applying fibrin glue in the same manner as in group A, a pedicled pericardial fat pad was immediately fixed to the leaking lung surface with fibrin glue. The duration of the postoperative air leakage and chest tube drainage was recorded. In 6 of 15 patients in group B the air leakage ceased within the first 24 h after pulmonary resection, while in group A only 1 of 15 patients showed a cessation of the air leakage, and a significant difference was noticed between the two groups (P = 0.0309). The duration of the postoperative air leakage was 4.8 ± 4.6 days in group A and 3.6 ± 3.4 days in group B. The pedicled pericardial fat pad fixed onto the surface of the leaking raw lung using fibrin glue was found to reduce alveolar air leakage after pulmonary resection. Received: January 11, 2001 / Accepted: September 11, 2001     

生物蛋白胶混合丝裂霉素治疗进展期胃癌

目的 观察胃癌手术中用生物胶蛋白混合丝裂霉素喷涂手术野联合口服化疗的疗效.方法 将64例确诊进展期胃癌患者随机分为治疗组和对照组.治疗组:32例行D2胃癌根治术,术中用生物胶蛋白混合丝裂霉素喷涂手术刨面进行术中淋巴化疗,术后口服希罗达化疗,服用3周停1周为1个疗程,共做6个疗程;对照组:32例进展期胃癌同样行D2胃癌根治术,术后口服希罗达化疗6个疗程.对比两组疗效.结果 治疗组和对照组的5年生存率分别为56.50%和37.25%,两者差异有统计学意义(P＜0.05),治疗组显著高于对照组.结论 术中应用生物胶蛋白混合丝裂霉素能提高胃癌术后化疗疗效.     

生物蛋白胶封堵术治疗高位肛瘘的临床研究

目的探讨生物蛋白胶封堵术治疗高位肛瘘的临床应用。方法将我科2010年3月至2011年4月期间60例高位肛瘘,随机分为治疗组和对照组各30例。治疗组采用生物蛋白胶封堵术,对照组采用肛瘘切除术,比较两组术后创面愈合时间、创面换药疼痛、肛管压力测定。结果治疗组术后疼痛及创面愈合时间均比对照组低（P〈0．05）;复发率的差异无统计学意义（P〉0．05）;术后肛管静息压比较,差异有统计学意义（P〈0．05）。结论生物蛋白胶封堵术治疗高位肛瘘有较好的效果,能缩短伤口愈合时间,减轻术后换药疼痛,保护肛管静息压。     

Usefulness of a New Gelatin Glue Sealant System for Dural Closure in a Rat Durotomy Model

Watertight dural closure is imperative after neurosurgical procedures, because inadequately treated leakage of cerebrospinal fluid (CSF) can have serious consequences. We used a rat durotomy model to test the usefulness of a new gelatin glue as a dural sealant in a rat model of transdural CSF leakage. All rats were randomly divided into one of the following three treatment groups: no application (control group: N = 18), application of fibrin glue (fibrin glue group: N = 18), and application of the new gelatin glue (new gelatin glue group: N = 18). The craniotomy side was re-opened, and CSF leakage was checked and recorded at 1, 7, and 28 days postoperatively. The new gelatin glue was adequate for stopping CSF leakage; no leakage was observed at postoperative days 1 or 7, and leakage was observed in only one rat at postoperative day 28. This result was statistically significant when compared to the control group (P = 0.002, P = 0.015, P = 0.015, respectively). The pathologic score of the new gelatin group was not different from that of the control or fibrin glue groups. We conclude that our new gelatin glue provides effective watertight closure 1, 7, and 28 days after operation in the rat durotomy model.     

急性肺损伤时胃黏膜pH值和肺微循环相关性研究

目的 探讨急性肺损伤(acute lung injury,ALI)时胃黏膜pH值(gastric intramucosal pH,pHi)与肺微循环的相关性. 方法 健康家兔24只,体重2.6～3.2 kg,采用随机数字表法分为3组(每组8只):对照组(C组)、模型组(M组)和治疗组(T组).麻醉稳定后30 min (T0),M组和T组制备兔ALI模型,模型制备成功后(T1),T组静脉输注前列腺素E1(prostaglandin E1,PGE1)30 ng·kg-1· min-1.分别于T0、T1及模型成功后30 min(T2)、60 min(T3)、90min(T4)、120min(T5)、150min(T6)、180min(T7),记录平均肺动脉压(mean pulmonary artery pressure,MPAP)、动脉血氧分压(pressure of artery oxygen,PaO2)、气道峰压(peakinspiratory pressure,PIP)及测量肺微循环和pHi.T7时记录支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)中中性粒细胞(polymorphonuclear neutrophils,PMN)及总细胞计数,计算肺湿/干重比(wet/dry,W/D).应用线性混合效应模型分析肺微循环和pHi的相关性. 结果 与C组比较,M组与T组T1～T7时PaO2降低,MPAP及PIP升高(P＜0.05);M组和T组BALF中PMN百分比和肺W/D升高(P＜0.05);M组T2～T7时pHi降低,T3～T7肺微循环血流量减少(P＜0.05).与M组比较,T组T3～T7时PaO2升高,T4～T7时PIP降低,T5～T7时MPAP降低(P＜0.05);T组BALF中PMN百分比[(20.341±0.033)比(40.232±0.054)]和肺W/D[(0.191±0.020)比(0.472±0.061)]降低(P＜0.05),T2～T7时pHi升高,T3～T7肺微循环血流量增加(P＜0.05).C组、M组和T组肺微循环的变化与pHi的变化相关(P＜0.05). 结论 随着肺损伤的产生和改善,肺微循环和pHi也发生相应的改变,二者具有相关性,可以通过pHi来预测肺损伤的情况.     

Fibrin glue and bioabsorbable felt patch for intraoperative intractable air leaks

Objective: We worked to devise a new way to prevent postoperative persistent air leaks in high-risk pulmonary surgery patients. Methods: From November 1993 to June 2002, 60 patients with difficult to control intraoperative pulmonary air leakage were treated using bioabsorbable polyglycolide felt patches soaked in fibrin glue to cover the leakage site. Results: After application, the felt patch adhered tightly to the lung surface without peeling off, enabling good leakage closure with only 2 ml of fibrin glue used. Air leakage was controlled successfully in 52 (86.7%) of the 60. Four of the 8 patients in whom this method failed to stop air leakage also developed mild pyothorax, with 2 requiring a second operation by video-assisted thoracic surgery. Leakage was eventually controlled in all patients, with no postoperative deaths relating to air leakage. Conclusions: Fibrin-glue-soaked bioabsorbable felt patches effectively seal intraoperative intractable air leaks. Felt patch use may increase the risk of postoperative infection. It should be considered for use on patients with fistulas that cannot be controlled by direct closure or otherwise intraoperatively and who may potentially develop uncontrollable air leakage postoperatively.     

肺动脉灌注抗肿瘤坏死因子-α抗体减轻体外循环的肺损伤

目的 探讨经肺动脉灌注抗肿瘤坏死因子-α抗体（TNF-αAb）对体外循环（CPB）肺损伤的保护作用及机制。 方法 健康新西兰大白兔40只,体重2.0～2.5 kg,雌雄不拘,随机分为4组,每组10只。Ⅰ组：CPB ＋单纯肺动脉灌注液;Ⅱ组：CPB ＋肺动脉灌注TNF-αAb;Ⅲ组：单纯CPB组;Ⅳ组：单纯开胸。测定4组CPB前、后左、右心房血液中性粒细胞计数、肿瘤坏死因子-α （TNF-α）、丙二醛（MDA）含量及氧合指数;取肺组织样本,在光学显微镜和电子显微镜下观察其病理变化和超微结构改变,并动态观察肺组织含水量、TNF-α mRNA表达及凋亡指数变化。 结果 与Ⅳ组比较,CPB后Ⅰ～Ⅲ组血浆中性粒细胞计数、TNF-α、MDA含量、肺组织TNF-α mRNA表达、凋亡指数均显著升高（P＜0.05）;肺组织含水量增加,而氧合指数显著下降（P＜0.05）,肺组织病理形态学发生改变。与Ⅱ组比较,CPB后Ⅰ组、Ⅲ组血浆TNF-α含量显著升高［主动脉开放5 min： （220.43±16.44） pg/ml vs. （185.27±11.78） pg/ml,P＜0.05; （249.99±14.09） pg/ml vs. （185.27±11.78） pg/ml,P＜0.05］,凋亡指数均显著升高（CPB停止即刻：60.7‰±13.09‰ vs. 37.9‰±7.78‰,P＜0.05;59.6‰±7.74‰ vs. 37.9‰±7.78‰,P＜0.05）,血浆中性粒细胞计数、MDA含量、肺组织TNF-α mRNA表达亦显著升高（P＜0.05）,肺组织含水量增加,而氧合指数显著下降（P＜0.05）,肺组织病理形态学改变明显。与Ⅰ组比较,Ⅲ组上述指标仅在CPB30 min显著升高（P＜0.05）,氧合指数显著下降（P＜0.05）。 结论 TNF-αAb经肺动脉灌注可明显抑制CPB期间炎性肺损伤,并减少肺组织细胞凋亡的发生。     

Influence of fibrin glue on seroma formation after breast surgery

BACKGROUND: This study was designed to determine the effectiveness of Hemaseel APR fibrin sealant versus conventional drain placement in the prevention of seromas after breast procedures. METHODS: A prospective, randomized, controlled study of subjects who were randomized into control (drain) and experimental (fibrin) groups was conducted. RESULTS: Analysis of 82 patients showed similarly matched groups. Seroma formation rate was 45.5% in the control group and 36.8% in the fibrin glue group (P = 0.43). The rate of wound complications was similar. Aspirate volumes were significantly greater in the fibrin glue group. Drain placement saved patients >366 US dollars over fibrin glue. CONCLUSIONS: Although use of fibrin sealant resulted in a nonsignificant decrease in seroma formation rate compared with that of drain placement, the higher cost involved, cumbersome technique, and higher aspirate volumes tend to indicate that there is no advantage to using fibrin glue over drain placement with the technique described.