丝素蛋白/磷酸钙骨水泥降低椎体成形术中心血管并发症风险的实验研究  

Animal experimental study on incorporation of silk fibroin reducing the risk of cardiovascular complication during vertebroplasty

作　　者：丁涛[1] 杨惠林[1] 徐瑞生[1] 吴继彬[1] 谢瑞娟[1] 陈晓庆[1] 

机构地区：[1]苏州大学附属第一医院骨科,江苏苏州215006

出　　处：《中国矫形外科杂志》2010年第8期667-672,共6页Orthopedic Journal of China

基　　金：国家自然科学基金资助项目(编号:30672140);江苏省卫生厅重点人才项目(编号:RC2007078);苏州市社会发展基金资助项目(编号:SS0713)

摘　　要：[目的]建立骨水泥肺栓塞动物模型,研究聚甲基丙烯酸甲酯、磷酸钙骨水泥及丝素复合磷酸钙骨水泥固相三种材料注射造成肺栓塞后,对血流动力学、肺氧合及凝血活酶的影响,探讨丝素改良骨水泥材料降低心血管系统并发症的可行性。[方法]24只实验用猪随机分为3组,每组8只,在全麻后气管插管,呼吸机维持下,开胸手术经肺动脉干分别注入聚甲基丙烯酸甲酯、磷酸钙骨水泥和丝素复合磷酸钙骨水泥固相,持续监测血流动力学参数,测定不同时间点动脉血pH值、动脉血氧分压(PaO2)和动脉血PaCO2浓度以及注射前后抗凝血酶Ⅲ活性(ATⅢ)。处死后肺标本行CT检查,立体三维重建骨水泥血管内铸形。[结果]注入磷酸钙骨水泥引起了肺动脉高压和低血压,平均肺动脉压的升高最高时比基础值增高(20.93±5.04)mmHg(注射后20 min),平均动脉血压下降最低时比基础值降低(-26.59±6.8)mmHg(注射后50 min);丝素复合磷酸钙骨水泥固相组的变化较轻微,与聚甲基丙烯酸甲酯组类似,丝素复合磷酸钙骨水泥固相组与磷酸钙骨水泥组比较差异有统计学意义(P<0.05)。注射骨水泥后磷酸钙骨水泥组血气指标改变明显,造成了严重的低氧血症、高碳酸血症和酸中毒,并引起了AT-Ⅲ明显的下降,丝素复合磷酸钙骨水泥固相及聚甲基丙烯酸甲酯对肺栓塞动物动脉血气和凝血指标的影响则较小。CT三维成像显示磷酸钙骨水泥体内有明显溃散,而丝素复合磷酸钙骨水泥固相则保持了较完整的骨水泥铸形。[结论]骨水泥的抗稀散性对肺栓塞后心血管并发症的严重程度有重要影响,丝素的复合使磷酸钙骨水泥在血液中的抗稀散性明显提高,有效地减少了栓子特别是微栓子的产生,能明显减轻骨水泥栓塞后对血流动力学、呼吸功能及凝血系统的影响,从而降低急性心肺功能障碍的发生率和死亡率。[ Objective] To develop an animal pulmonary cement embolism model,by which the effect of polymethylmethacrylate （PMMA） ,calcium phosphate cement （CPC） and silk fibroin/calcium phosphate cement composite （SF/CPC） on the hemodynamic change, respiratory function and the antithrombin activity were measured after the pulmonary embolism caused by cement injection. The efficiency of SF reducing the risk of cardiovascular complication was evaluated. [ Method ] Twenty-four pigs were assigned to 3 groups randomly,with 8 pigs in each group. After general anesthesia,animals were endotracheal intubated and mechanically ventilated by a respirator. The pulmonatT trunk was exposed via sternotomy and each kind of cement was injected into the main pulmonary artery. Hemodynamic parameters were continuously monitored. Blood samples were drawn at certain time points for bh）od gases analyzing and measurement of AT Ⅲ. Postmortem lungs were subject to computer tomography （CT） examination along with three-dimensional reconstructions of cement casts. [ Result] The injection of CPC caused severe pulmonary hypertension and arterial hypotension,with a maximum elevation of 20.93 ± 5.04 mmHg in PAP （20 min post-injection） and a maximum decrease of -26.59 ± 6.8 mmHg in MABP （50 rain post-injection）. The changes in SF/CPC group were relatively slighter, which is similar with PMMA group, having a statistically significant difference from CPC groups（ P 〈0.05 ）. Blood gases revealed significant hyperearbia,acidemia,hypoxemia and a sharp drop of AT Ⅲ level in CPC group after injection,while these respiratory impairments and change of coagulation were mild in SF/CPC and PMMA group. CT images showed an obvious decay of CPC while SF/CPC casts kept fairly intact. [ Conclusion] The results indicated that,the washout resistance properties of cements significantly influenced the severity of cardiovascular complications post pulmonary embolism. The incorporation of SF evidently improved the stability of CPC that effect

关 键 词：椎体成形术 丝素蛋白 磷酸钙骨水泥 肺栓塞 猪 动物模型 

分 类 号：R687.3[医药卫生—骨科学]