腔静脉置管不同时相血管局部炎症变化及血管重构研究  

Effect of central vein catheters at different times on focal vessel wall in New Zealand white rabbits

作　　者：位娟[1] 赵庆华[1] 赵渝[2] 杨冰[1] 

机构地区：[1]重庆医科大学附属第一医院护理部 [2]重庆医科大学附属第一医院血管外科,重庆400016

出　　处：《重庆医科大学学报》2010年第9期1361-1364,共4页Journal of Chongqing Medical University

摘　　要：目的:通过研究新西兰兔中心静脉置管(Central vein catheters,CVC)后内皮、管壁及炎症相关因子的动态变化,来探讨动物体内适宜的置管周期。方法:42只新西兰兔不拘雌雄随机分为7个时相点,每时相点6只,均于麻醉后从右颈外静脉插入导管至右前腔静脉。置管后当天(0d)、1、2、3、4、5周和6周后处死模型取目标标本,做如下检测:①导管培养;②在扫描电镜下观察内皮细胞(Endothelial cells,EC)的损伤;③HE染色后,光镜下观察血管壁病理改变;④免疫比浊法检测C-反应蛋白(C-reaction protein,CRP)和纤维蛋白原(Fibrinogen,FIB)的含量。结果:①导管培养结果均为阴性。②EC损伤:逐渐加重,4周损伤与3周比差异显著(P<0.05)。③光镜下观察标本,4周时部分管壁炎症反应,5、6周时部分管壁可见血栓、血栓钙化。④CRP和FIB在4周时显著升高分别为(67.5±9.2)mmg/L、(4.41±0.46)g/L,与前3周相比差异均有统计学意义(P<0.05)。结论:随着中心静脉置管时间的延长,4～5周时血管内皮损伤及炎症反应明显,可能导致组织发生不可逆的病理改变,引起血管重构。Objective：To investigate the changes of EC、vessel wall and CRP after Central Vein Catheters at different times and determine a proper retention time.Methods：Models of central vein catheterization were established in 42 rabbits.And the animals were randomized into seven phases of six rabbits each according to catheter indwelling times of 0 d,1 week,2,3,4,5 week and 6 week.Immunoturbidimetry was used to detect the CRP and FIB of Blood specimens.After the animals were sacrificed,the catheter,access vein were dissected.The catheters were cultivated,Histological evaluation was performed by using standard light microscopy on Hematoxylin-eosin stained specimens.Scanning electron microscopy was used to observe the damage of endothelial cells.Results：①All catheters cultivated：（-）;②The endothelia damage were more severe at 4 week than 3 week（P0.05）;③Inflammation reaction were found at 4week,thrombus and calcification at 5 week and 6 week;④The expression of CRP and FIB started the day after intubations and reached the maximum at 4week than 3week（P0.05）.Conclusion：After CVC,The damage of EC and inflammation reaction are severe at 4 week.

关 键 词：中心静脉置管 内皮损伤 C-反应蛋白 内膜修复 

分 类 号：R329.4[医药卫生—人体解剖和组织胚胎学]