壳聚糖膜预防术后腹腔粘连及其作用机制的研究

目的研究壳聚糖防粘连膜在大鼠粘连模型中的防止术后腹腔内腹膜粘连的作用,并对其可能的作用机制进行探讨。方法sD大鼠60只,随机分成两组,对照组（肠粘连模型组）n=30;实验组（壳聚糖薄膜组）n=30。比较两组动物在术后第1天,3天,7天,60天,90天的时间段腹腔粘连发生率和程度,并用光学显微镜和电镜对腹腔内粘连的标本进行病理观察,比较腹膜的反应情况。结果对照组的各时间段发生的粘连程度与粘连的发生率比实验组都要高。实验组的重新腹膜化比对照组明显要完整。结论壳聚糖防粘连膜能明显地减少腹腔术后粘连的发生。     

卡巴胆碱预防术后腹腔粘连的实验研究

目的 观察拟胆碱药卡巴胆碱预防腹腔粘连的作用。方法 44只雄性Wistar大鼠按完全随机法分为假手术组（n=12）、手术对照组（n=16）及卡巴胆碱组（n=16，卡巴胆碱50ug／kg），后2组采用开腹后无菌干纱布摩擦大鼠盲肠蚓突部，钳夹和刮伤腹壁法制作大鼠腹腔粘连动物模型。各组于术后第7d和第14d各处死一半动物，参考Phillips 5级分类法并结合本模型特点进行大体粘连程度分级评分；取粘连组织切片行HE染色观察粘连组织病理变化，免疫组化法观察粘连组织Ⅰ型胶原含量变化，并进行图像分析。结果 卡巴胆碱组第7d与第14d大体粘连程度评分均明显低于手术对照组，差异有统计学意义（P〈0．01）；HE染色显示卡巴胆碱组比之手术对照组炎症反应轻，偶见增生纤维结缔组织；Ⅰ型胶原含量卡巴胆碱组第7d与第14d均明显低于手术对照组（P〈0．01）；各组内第7d与第14d比较，腹腔大体粘连程度评分和I型胶原含量差异无统计学意义（P〉0．05）。结论 拟胆碱药卡巴胆碱能显著预防大鼠腹腔粘连形成，降低粘连程度。     

化学改性壳聚糖膜预防不同类型腹膜粘连的实验研究

目的对比研究化学改性壳聚糖膜对四种不同原因所致的大鼠腹膜粘连的预防作用。方法将壳聚糖行化学改性,制成厚60μm的膜消毒后备用。SD大鼠200只,随机分成假手术对照组（A组）、创伤致粘连组（B组）、滑石粉致粘连组（C组）、结扎血管致粘连组（D组）及感染致粘连组（E组）。各组分别用相应的方法来处理大鼠蚓突盲端．再将每组大鼠分成对照组和实验组．对照组大鼠直接关腹,实验组用凝胶化改性壳聚糖膜覆盖蚓突盲端浆膜面．然后关腹。处理后2周和4周后打开腹腔,以Bhatia分级法评定蚓突盲端的粘连程度,并对盲端组织行羟脯胺酸（hydroxyproline,OHP）、组织型纤溶酶原激活剂tissue—type plasminogen activatior,t—PA）和纤溶酶原激活物抑制因子（plasminogen activator inhibitor,PAI）水平测定,对腹腔液行t—PA、PAI测定。结果①粘连程度和OHP水平：术后2周和4周,B、D、E组中实验组的粘连程度、OHP水平均分别显著低于对照组（P〈0．05）,而A、C组中的实验组和对照组间差异均无统计学意义（P〉0．05）;②t-PA、PAI水平：术后2周和4周,A组、C组和D组的蚓突组织和腹腔液t—PA、PAI水平．实验组和对照组间差异均无统计学意义（P〉0．05）;B组、E组中实验组t—PA水平均显著高于对照组（P〈0．05）,而PAI水平则显著低于对照组（P〈0．05）。结论化学改性壳聚糖膜时创伤、缺血及感染所致的腹膜粘连有明显的预防作用,而对滑石粉所致的腹膜粘连则作用不明显;对不同原因所致的腹膜粘连．可以用来准确衡量组织粘连程度的指标也不尽相同。     

电针足三里穴减轻大鼠术后腹腔粘连的实验研究

目的：观察电针刺激足三里穴对大鼠术后腹腔粘连的预防作用。方法：44只雄性Wistar大鼠随机分为假手术组（n=12）、腹腔粘连组（n=16）、电针足三里组（n=16）。采用开腹后无菌干纱布摩擦大鼠盲肠蚓突盲端,继之损伤侧腹壁法制作大鼠腹腔粘连动物模型。各组于术后7d和14d各处死一半动物,参考Phillips五级分类法评估腹腔粘连程度并计分。取粘连组织切片,分别行苏木素-伊红（HE）染色观察粘连组织病理学变化及免疫组化染色观察粘连组织I型胶原含量变化,并进行图像分析。结果：电针足三里组腹腔粘连组织面积明显减少,7d与14d大体粘连评分均明显低于腹腔粘连组（P〈0.01）。HE染色显示,与腹腔粘连组比较,电针足三里组炎症反应轻,增生纤维结缔组织少;I型胶原免疫组化染色结果显示,电针足三里组累积吸光度值（29211±21334）显著低于腹腔粘连组（124189±48314）,差异有显著性（P〈0.01）。结论：电针刺激大鼠足三里穴可显著减轻大鼠腹腔粘连形成。     

凝胶化改性壳聚糖膜预防腹膜粘连的效果研究

目的对比研究凝胶化改性壳聚糖膜和透明质酸钠对腹膜粘连的预防作用。方法SD大鼠80只,随机分成4组：假手术对照组（A组）,生理盐水对照组（B组）,凝胶化改性壳聚糖膜组（C组）,透明质酸钠组（D组）。利用大鼠蚓突盲端制作创伤性腹膜粘连模型,然后每组分别用相应的方法处理创面,处理后第2周和第4周打开腹腔,以Bhada分级法评定蚓突盲端的粘连程度,并对盲端组织行羟脯胺酸（OHP）水平测定和病理组织学检查。结果术后第2周和第4周,C,D组的粘连程度均显著轻于B组（P=0．001～0．013）,OHP水平显著低于B组（P=0．037～P〈0．001）;C组和D组比较,粘连程度分级的差异两组间无显著性意义（P〉0．05）,但OHP含量C组显著低于D组（P=0．005,0．002）。病理学检查：A组所有大鼠蚓突组织无明显的病理改变,B组术后第2周时处理侧浆膜面有明显的炎症细胞浸润和纤维组织增生,术后第4周局部主要以纤维组织增生为主;相应的病理改变C,D组较B组明显减轻,C组的病理改变又明显轻于D组。结论凝胶化改性壳聚糖膜具有明显的抗腹膜粘连作用,且此作用较透明质酸钠具有优势。     

Fe3+改性羧甲基纤维素对腹腔粘连预防作用的研究

目的　探讨Fe3 改性羧甲基纤维素对术后腹腔粘连的预防作用。方法　将 2 4只大鼠随机分为A、B、C 3组 ,先行均制作肠粘连模型 ,取A组为对照组 ,B组、C组于腹腔内损伤部位分别注入羧甲基纤维素钠及Fe3 改性羧甲基纤维素 ,术后 10d处死动物 ,观察各组腹腔粘连情况。结果　C组轻微粘连 ,A组广泛粘连 ,致密。 3组粘连分级差异有显著性意义 (P <0 .0 1) ,结论　Fe3 改性羧甲基纤维素明显减轻术后腹腔粘连程度 ,其作用优于羧甲基纤维素钠     

通腑泻热灌肠合剂对大鼠术后腹腔粘连及血TNF-α水平的影响

目的：观察通腑泻热灌肠合剂对大鼠腹腔粘连模型血TNF－α、IL－8的影响，探讨血TNF－α、IL－8含量与腹腔粘连级别的关系及合剂预防术后腹腔粘连的机理。方法：将模型SD大鼠随机分为两组：中药治疗组和对照组，分别测定治疗前后血TNF－α、IL－8含量，术后第14d记录大鼠腹腔粘连级别，并作血TNF－α、IL－8含量与粘连级别相关性分析。结果：治疗后中药治疗组血TNF－α水平较对照组降低（P＜0．01），血TNF－α含量与术后腹腔粘连级别存在线性正相关（r=0．424，P＜0．05）；治疗前后两组血IL－8水平比较无显著性差异。结论：通腑泻热灌肠合剂能降低术后腹腔粘连级别和TNF－α含量。血TNF－α可能成为预测术后腹腔粘连严重程度有意义的观测指标。     

羧甲基纤维素透明质酸钠预防术后腹膜粘连的实验研究

目的 探讨羧甲基纤维素透明质酸钠复合物（CMC-HA）在腹膜粘连预防中的价值.方法 将90只Wistar大鼠分为A、B、C 3组,每组30只,制成腹膜粘连模型后分别于创面置入羧甲基纤维素（CMC）、透明质酸钠（HA）和CMC-HA各3 ml,分别于术后3 d、7 d和14 d观察腹腔粘连情况.结果 术后3 d于光镜下可见,与A组和B组相比,C组大鼠肠壁纤维细胞增生较轻,胶原纤维排列较疏松.术后14 d,C组大鼠腹膜粘连程度明显轻于A组和B组（均P＜0.01）.结论 CMC-HA预防术后腹膜粘连安全有效.     

壳聚糖膜置入预防膝关节术后粘连的实验研究

目的：观察在兔膝关节滑膜切除术中置入壳聚糖膜以预防术后关节粘连的效果。方法：将32只新西兰白兔随机分为两组，壳聚糖膜组（实验组）和对照组。所有动物均行右侧膝关节滑膜切除术，术中实验组在滑膜切除区域放置壳聚糖膜，对照组不放膜。术毕，右下肢石膏管型固定4周。对每组动物行右膝关节的大体观察、半定量计分、组织学观察、生物力学分析及生物化学分析，所有的定量数据经t检验进行比较。结果：半定量计分结果表明对照组的粘连程度较严重，差异有显著性意义（P＜0．05）。光镜下组织学观察显示，对照组有大面积致密的厚纤维组织形成，实验组有松散的极薄的纤维组织形成。生物力学试验结果表明，实验组膝关节屈曲挛缩的角度小于对照组，差异有非常显著性意义（P＜0．01）。生化分析结果表明，实验组粘连组织中的总胶原含量明显低于对照组，差异有非常显著性意义（P＜0．01）；而实验组Ⅲ型胶原所占的比例高于对照组，差异有显著性意义（P＜0．05）。结论：壳聚糖膜组关节粘连的程度明显低于对照组，壳聚糖膜可以有效预防膝关节术后粘连。     

卡铂复合液对大鼠腹腔内化疗后腹膜I型和Ⅲ型胶原mRNA表达的影响

目的：为进一步探讨含有透明质酸钠和人体白蛋白的卡铂复合液对腹腔内化疗后腹腔粘连的抑制作用。方法：采用斑点杂交和原位杂交方法观察卡铂复合液对大鼠腹腔内化疗后腹膜组织Ｉ型和Ⅲ型胶原ｍＲＮＡ水平影响。结果：卡铂复合液腹腔内化疗后第２１天和第４８天大鼠腹膜组织中α１（Ｉ）和α１（Ⅲ）胶原ｍＲＮＡ水平明显低于卡铂液组（Ｐ〈０．０１），其腹腔内粘连发生率和粘连程度显著低于卡铂液组（Ｐ〈０．００１）。原位杂交结     

几丁糖对大鼠术后腹腔粘连的预防作用

目的　探讨几丁糖对术后腹腔粘连的预防作用。方法　将 45只大鼠随机分为对照组 (A组 ) ,右旋糖酐组 (B组 ) ,几丁糖组 (C组 ) ,于腹腔内浆膜损伤部位分别注入 1%乳酸液 ,3 2 %右旋糖酐 -70液 ,2 %几丁糖乳酸液各 2ml ,术后 14d处死动物 ,观察各组腹腔粘连状况并送病理检查。结果　 3组粘连分级有显著性差异 (P <0 .0 1) ;C组粘连发生率较另 2组为低 ,有显著性差异 (P <0 .0 5 )。光镜下C组炎症反应轻微 ,纤维增生不明显 ;电镜下C组纤维细胞分泌胶原能力弱 ,间皮细胞增生活跃。结论　几丁糖可有效地降低大鼠术后腹腔粘连的发生和粘连程度 ,其作用优于右旋糖酐 -70 ,且不影响切口的愈合。     

自制新型冷敷袋在膝关节镜术后患者中的应用

目的 探讨更有效的减轻膝关节镜术后关节肿痛的冷敷方法.方法 将296例膝关节镜术后患者随机分为对照组(144例)和观察组(152例).对照组采用毛巾包裹清水冰袋进行冷敷,观察组采用自制新型冷敷袋进行冷敷,术后当天冰敷2h,术后第1～5天每天冰敷2次,每次2小时.结果 两组术后第3天舒适度,术后6h、24 h、48 h疼...     

Comparison between powdered gloves, powder-free gloves and hyaluronate/carboxymethylcellulose membrane on adhesion formation in a rat caecal serosal abrasion model

OBJECTIVE: Intraabdominal adhesion formation and prevention is one of the major conflicts of modern surgery. We aimed to determine the effects of powdered gloves versus powder-free gloves and hyaluronate/carboxymethylcellulose membrane (H/CMCm) in a rat caecal serosal abrasion model. METHODS: Sixty wistar albino rats were subjected to a standardized lesion by caecal abrasion model. In group 1, the procedure was performed with sterile powdered gloves. In group 2, the procedure was performed with powder-free sterile gloves. The H/CMCm was applied directly to the abraded caecum in group 3. Formation of adhesions were determined on one half of the animals from each group on the 7th postoperative day, and on the other half on the 15th postoperative day. RESULTS: There was a statistically significant difference between the adhesion scores on day 7 and 15 in groups 1 and 2 (p = 0.005, p = 0.007). There was no significant difference in adhesion scores on day 7 and 15 in group 3 (p = 0.145). The mean adhesion score was significantly higher in group 1 (powdered glove group) than group 2 (powder-free glove group) and group 3 (powder-free glove plus H/CMCm) on postoperative day 7 (p = 0.001). However, no significant difference was found between groups regarding adhesion scores on postoperative day 15 (p = 0.607). The comparisons of group 2 versus group 3, both on postoperative day 7 (p = 0.051) was not statistically significant, whereas a significant difference was detected between group 1 versus group 2 and group 3 on postoperative day 7 (p = 0.013, p = 0.001). CONCLUSION: Our experiment shows that the use of powder-free gloves may be as beneficial as Seprafilm in preventing postoperative adhesion formation.     

The Preventive Effect of Rofecoxib in Postoperative Intraperitoneal Adhesions

Background: Previous studies showed that nonsteroidal anti-inflammatory (NSAi) drugs suppressed prostaglandin synthesis and were able to prevent adhesion formation following surgical trauma to the peritoneum. The selective suppression innammatory cascade may prevent adhesion formation. Therefore, we planned this study to experimentally evaluate the effects of Rofecoxib, the selective cyclo-oxygcnase-2 inhibitor, in postoperative intraperitoneal adhesions in an animal model.

Methods: Male Sprague-Dawley rats were divided into three groups of 10. All rats underwent midline laparotomy under ketamine anaesthesia (25 mg/kg im). In group 1 (n = 10), the sham operation group (SG) ; abdominal walls were closed without any process after 2 minutes. In Group 2 (n = 10), the control group (CG) ; standard serosal damage was constituted and the abdominal wall was closed. In group 3 (n = 10), the COX-2 group (COXG), after serosal damage, the abdominal wall was closed. A 12 mg/kg/day dose of was given orally to the rats during one week. On the 7th postoperative day, all rats were sacrificed and intra-abdominal adhesions were evaluated both macroscopically and microscopically.

Results: Macroscopically, no serious adhesion formations were seen in the SG. Multiple adhesion format ions of the CG were significantly more than those of the SG (p < 0.0001). It was determined that adhesions of the COXG diminished (p < 0.0001) when macromorphological adhesion scale results of the COXG were compared with those of the CG. The adhesion scores of the CG were compared microscopically with those of the COXG and granulation tissue formation and fibrosis in the COXG were found to be significantly less than those of the CG (respecti vely p = 0.002, p < 0.0001).

Conclusions: We were of the opinion that Rofecoxib, the selective cyclo-oxygenase inhibitor, was effective in the prevention of postoperative peritoneal adhesions.     

奥曲肽联合透明质酸钠预防兔术后腹膜粘连的疗效评价

目的: 观察奥曲肽联合透明质酸钠预防兔术后腹膜粘连的效果。方法:建立兔术后腹膜粘连模型,然后分为4组：（1）术中不用药物处理设为模型对照组;（2）关腹前局部涂抹透明质酸钠设为透明质酸钠组;（3）关腹前腹腔内注射奥曲肽设为奥曲肽组;（4）关腹前局部涂抹透明质酸钠同时腹腔内注射奥曲肽设为联合组。术后14d剖腹观察,判定腹膜粘连程度等级。结果:4组粘连发生率比较无统计学意义(χ2＝3.51, P>0.05);联合组重度粘连发生率(8.3%)显著低于其它3组（分别为66.7%,33.3%,25.0%）(均P<0.01)。奥曲肽组和透明质酸钠组两组的粘连级别近似（P> 0.05）。结论:奥曲肽和透明质酸钠均可减轻实验性腹膜粘连的程度和重度腹膜粘连发生率,两者合用其作用更明显,表明两药合用具有降低粘连的协同作用。     

右美托咪定术前滴鼻对全麻患儿术后行为改变的影响

目的观察右美托咪定术前滴鼻对全麻患儿术后行为改变的影响。方法择期在全麻下行疝囊高位结扎术的患儿60例,男46例,女14例,年龄2~5岁,体重10~30kg,ASAⅠ或Ⅱ级。采用随机数字表法,将其均分为三组:对照组(C组)、咪达唑仑组(M组)和右美托咪定组(D组)。麻醉诱导前30min,C组生理盐水0.02ml/kg滴鼻,M组咪达唑仑0.2mg/kg滴鼻,D组右美托咪定2μg/kg滴鼻。记录患儿与父母分离时的镇静评分及七氟醚诱导时的面罩接受程度评分;记录患儿术后恢复时间、术后并发症及镇痛药补救率等情况。分别在术前1d、术后1、7、30d用术后行为量表(PHBQ)对患儿父母进行术前问卷调查及术后电话随访,观察患儿术后行为改变的情况。结果M组和D组与父母分离时的镇静评分及七氟醚诱导时的面罩接受程度评分明显高于C组(P0.05)。D组苏醒期躁动、恶心呕吐及镇痛药补救率明显低于C组和M组(P0.05)。术后1、7d时M组和D组行为改变的发生率明显低于C组(P0.05)。结论右美托咪定术前滴鼻可以降低全麻患儿术后行为改变的发生率。     

医用羧甲基壳多糖用于改善甲状腺术后颈部活动舒适度的效果分析

目的研究医用羧甲基壳多糖改善甲状腺术后颈部活动舒适度的效果。 方法选择郑州人民医院2013年1月至9月收治的96例甲状腺疾病手术患者的临床资料,分为试验组和对照组,试验组术中使用医用羧甲基壳多糖涂抹在气管与颈部肌群间或颈前肌群与皮瓣间,对照组不使用医用羧甲基壳多糖,评估甲状腺术后30 d及90 d颈部活动舒适度。 结果甲状腺术后30 d及90 d试验组患者颈部活动舒适度明显高于对照组,差异有统计学意义（Z₁=-5.652,P₁=0.000;Z₂=-6.418,P₂=0.000）。 结论医用羧甲基壳多糖具有改善甲状腺患者术后颈部活动舒适度的效果,值得临床推广应用。     

Thalidomide given intraperitoneally reduces the number of postoperative adhesions after large bowel resection in rabbits.

OBJECTIVE: To investigate the effect of thalidomide given intraperitoneally on the formation of adhesions after colonic resection in rabbits. DESIGN: Controlled, randomised prospective study. SETTING: University hospital, Germany. ANIMALS: 40 female New Zealand White rabbits. Interventions: After an end-to-end colonic anastomosis the animals were given thalidomide 200 mg/kg in 1% carboxymethylcellulose intraperitoneally or carboxymethylcellulose alone (n = 20 in each group). OUTCOME MEASURES: The adhesion score according to Tyrell on day 3 (n = 20) and day 7 (n = 20) postoperatively, weight, behaviour, and white cell count (WCC). RESULTS: There was no difference in behaviour or weight. On the third postoperative day WCCs and on the seventh postoperative day WCCs and adhesion scores, were lower in the thalidomide group (p < 0.01). CONCLUSION: The number of postoperative adhesions was reduced in the group given thalidomide intraperitoneally. Our results suggest that thalidomide may be helpful in the prevention of postoperative adhesions.     

Methylene blue prevents surgery-induced peritoneal adhesions but impairs the early phase of anastomotic wound healing.

OBJECTIVES: Adhesion formation continues to be an important problem in gastrointestinal surgery. In recent years, methylene blue (MB) has been reported to be an effective agent for preventing peritoneal adhesions. However, its effects on the wound healing process are unknown. In the present study, we investigated the effects of MB on the early and late phases of anastomotic wound healing and on adhesion formation. METHODS: We randomly categorized 92 rats into 2 groups in bursting pressure measurements and 50 rats into 3 groups in the adhesion model. We divided the animals into saline-treated (n = 46) or MB-treated (n = 46) groups. Bursting pressures of the anastomoses were measured on postoperative days 3 and 7. In biochemical studies, tissue hydroxyproline levels, total nitrite/nitrate levels and nitric oxide synthase activity were measured on postoperative days 3 and 7. In the adhesion model, we randomly categorized rats into sham (n = 10), saline-treated (n = 20) and MB-treated (n = 20) groups, and the formation of intraperitoneal adhesions was scored on postoperative day 14. We compared the measurement of bursting pressure and biochemical measurements of tissue hydroxyproline levels, total nitrite/nitrate levels and nitric oxide synthase activity. Histopathological findings of specimens were presented. RESULTS: During the early phase of wound healing (postoperative day 3), bursting pressures, tissue hydroxyproline, total nitrite/nitrate levels and nitric oxide synthase activity in the MB-treated group were significantly lower than those of the saline-treated group. On postoperative day 7, there was no significant difference in these parameters between MB and saline-treated groups. In the adhesion model, MB caused a significant reduction in the formation of peritoneal adhesions. CONCLUSION: MB prevents peritoneal adhesions but causes a significant impairment of anastomotic bursting pressure during the early phase of the wound healing process by its transient inhibitory effect on the nitric oxide pathway.