多种干预措施预处理骨髓腔预防骨水泥植入综合征的研究

目的 探讨兔髋关节置换术中扩髓后肾上腺素盐水、股骨扩髓区域钻孔及纤维蛋白医用胶(FS胶)对髓腔预处理及其联合应用对术中骨水泥植入综合征的预防作用.方法 采用2×2×2析因实验设计,将欲行单髋关节置换术的48只比利时兔随机分成8组.分别给予扩髓后肾上腺素盐水冲洗髓腔(盐酸肾上腺素组)、股骨扩髓区域钻孔(钻孔组)、纤维蛋白医用胶喷涂髓腔(FS胶组)以及上述干预措施联合应用处理骨髓腔.使用BL-420E+生物机能实验系统实时监测各组家兔外周动脉压、中心静脉压、心率、呼吸频率的变化,收集数据并作统计学分析.夹闭气管处死家兔后取下肺脏送病理检验,高倍镜观察微栓子.结果 FS胶组、肾上腺素盐水冲洗+钻孔和肾上腺素盐水冲洗+钻孔+FS胶3种方法联合应用组血压下降幅度减少,血压下降值分别为(14.96±2.60)、(17.58±2.06)和(21.67±5.52)mm Hg(1 mm Hg=0.133 kPa);盐酸肾上腺素组、FS胶组、肾上腺素盐水冲洗+FS胶联合应用组、FS胶+钻孔联合应用组、肾上腺素盐水冲洗+钻孔+FS胶3种方法联合应用组血压下降持续时间减少,低血压持续时间分别为(30.00±5.62)、(26.17±2.64)、(27.17±3.87)、(22.00±3.69)、(20.17±5.04)s.结论 肾上腺素盐水冲洗,FS胶及其肾上腺素盐水冲洗+FS胶联合应用、FS胶+钻孔联合应用、肾上腺素盐水冲洗+钻孔联合应用、肾上腺素盐水冲洗+钻孔+FS胶联合应用对骨水泥致血压下降有预防作用;钻孔对血压下降无预防作用,但对肾上腺素盐水冲洗,FS胶处理有协同作用.

Different pretreatments to prevent bone cement implantation syndrome in hip arthroplasty

Objective To investigate possible methods to prevent the adverse effect of bone cement implantation syndrome(BCIS)during hip arthroplasty by the rabbit model.Methods Forty-eight Belgium rabbits of either sexes,1.8-2.4 kg body weight,were armesthetized with intravenous pentobarbitone sodium (10 mg/kg body weight)and anaesthesia was maintained by additional doses of pentobarbitone sodium.The 48 Belgium rabbits(48 hips)were assigned to 8 groups randomly.The control group consisted of 6 rabbits,treated with conventional cementing technique:group 1-7 pretreated the medullary cavity with adrenaline (1:10000),drilling holes in femur,fibrin sealant or combined with these factors before having cement and femoral prosthesis inserted.Arterial blood pressure,central venous pressure and respiration rate were recorded at the carotid artery.the external jugular vein and the tracheal cannula by BL-420E+biological functional experimental system respectively.Data were collected and analyzed with SPSS.Specimens were taken from each lobe of the lung.11le tissue sections were observed.Results The decline in blood pressure in groups C (14.96±2.6)mm Hg,D(17.58±2.06)mm Hg,and G(21.67±5.52)mm Hg was more significant than that in the control group,and the duration of blood pressure drop was shorter in groups A(30.00±5.62)s,C(26.17±2.64)s,E(27.17±3.87)s,F(22.130±3.69)s,and G(20.17±5.04)s.Condusion Adrenaline saline.fibrin sealant and combined use of adrenaline and fibrin sealant.combined use of fibrin sealant and drilling holes.combined use of adrenaline and drilling holes can prevent the decline in blood pressure during the HA.Drilling holes have no effect,but can play a synergistic role with fibrin sealant.