两种组织黏合剂封堵肺创面漏气的研究

目的 探讨纤维蛋白胶(FG)和化学胶封堵肺创而漏气的临床价值.方法 FG先行体外耐压试验.将54只新西兰兔随机分为3组:对照组、FG组和化学胶组,每组18只.离体实验每组9只兔,分别注射40、50、60 ml空气行肺顺应性测定.在体实验每组9只兔,建立兔肺漏气模型.对照组关胸,另两组行FG及化学胶封闭肺创面做加压试验,术后3、7、14 d开胸观察取肺组织行苏木素-伊红(HE)染色.结果体外耐压试验中,FG承受50 cm H2O压力后出现漏气.离体实验中,FG组顺应性(1.820±0.280、1.181±0.144、0.947±0.080)与对照组(2.075±0.377、1.289±0.243、0.951±0.087)比较差异无统计学意义(P>0.05),化学胶组顺应性(1.594±0.294、0.956±0.094、0.861±0.076)与对照组、FG组比较明显减小(P<0.05).在体实验中,对照组兔在术后1～4 h内死亡,FG组在肺内压平均达到27.2 cmH2O时出现漏气,而当气道压达34 cmH2O时化学胶亦未漏气.化学胶组术后出现肺不张及少量胸水,病理切片示坏死组织及炎性细胞明显多于FG组.结论 两胶均可有效封闭肺创面漏气.与化学胶比较,FG对肺顺应性干扰小,可促进创面愈合、减轻炎症及瘢痕形成.

Study on two kinds of tissue adhesives effect in sealing pulmonary wound

Objective To investigate the value of fibrin glue (FG) and chemical glue in sealing pulmonary wound.Methods A apparatus was established to test the capacity of pressure resistant of fibrin glue.Fifty-four New Zealand rabbits were randomly divided into three groups,control group,FG group and chemical glue group,eighteen rabbits in each group.In vitro experiment,pulmonary compliances were measured different capacity (40,50,60 ml).In vivo experiment,models were constructed on the lung surface.The control group was closed chest.FG and chemical glue were applied to seal pulmonary wound and lung pressure was tested.After operation,on the 3rd,7th,14th day,we did surgery to observe and take the lung tissue,stained by Hematoxylin and Eosin (HE).Results Air leakage was happened when FG bored 50 cm H2O.In vitro experiment,There was no difference between FG group ( 1.820 ± 0.280,1.181 ±0.144,0.947 ±0.080) and control group (2.075 ±0.377,1.289 ±0.243,0.951 ±0.087)( P ＞ 0.05 ),while there was significant difference between chemical clue group ( 1.594 ± 0.294,0.956 ±0.094,0.861 ± 0.076) and control group ( P ＜ 0.05 ),as well as FG group and chemical glue group ( P ＜0.05 ).In vivo experiment,control group rabbits was died in one to four hours.When average intrapulmonary pressure reached 27.2 cm H2O,the lungs showed air leakage in FG group,while chemical glue group was not.After operation,chemical glue group appear pulmonary atelectasis and little hydrothorax,and pathological indicated necrotic tissues and inflammatory cells were more than the FG group.Conclusion The two glues could seal pulmonary wound.Compared with chemical glue,FG is more feasible in the clinical.