全生物可降解型封堵器封堵猪房间隔缺损的实验研究  

Experimental study of the fully biodegradable occluder in a swine model of atrial septal defect

作　　者：牛云鹤 罗历[1] 李勇刚[2] 计晓娟[1] 白永虹[1] 王洪[1] 蒲晓芳[1] 刘玲娟[3] 易岂建[1] Niu Yunhe Luo Li Li Yonggang Ji Xiaojuan Bai Yonghong Wang Hong Pu Xiaofang Liu Lingjuan Yi Qijian(Deportment of Cardiovascular Medicine, the Children＇ S Hospital, Chongqing Medical University Department of Cardiothoracic Surgery,the Children＇s Hospital, Chongqing Medical University China International Science and Technology Cooper~ion Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders)

机构地区：[1]重庆医科大学附属儿童医院心血管内科,重庆400014 [2]重庆医科大学附属儿童医院心胸外科,重庆400014 [3]重庆医科大学附属儿童儿童发育重大疾病国家国际科技合作基地、儿科学重庆市重点实验室、儿童发育疾病研究教育部重点实验室,重庆400014

出　　处：《重庆医科大学学报》2016年第10期1045-1050,共6页Journal of Chongqing Medical University

基　　金：重庆市卫生局重点资助项目(编号:2011-1-065)

摘　　要：目的:评估全生物可降解型房间隔缺损(atrial septal defect,ASD)封堵器封堵猪ASD的疗效、组织覆盖情况、降解情况及生物相容性等。方法:15只小型猪经外科开胸术后在心脏超声指引下行房间隔穿刺术,并置入全生物可降解ASD封堵器。术后行心脏超声检查观察封堵效果并测量封堵器大小,于1个月、3个月、6个月及9个月各处死3只,大体肉眼观察组织覆盖情况并测量覆盖面积与封堵器双盘面积;苏木素-伊红染色法(hematoxylin-eosin staining,HE)观察周围组织的炎症反应,酶联免疫吸附分析(enzyme-linked immunosorbent assay,ELISA)测定猪血清白介素-6(interleukin-6,IL-6)水平。结果:除了3只建模失败,其余12只均建模成功并进行了ASD封堵;术中及术后未出现感染、封堵器脱落等并发症。超声结果显示封堵器位置良好,无残余分流。大体解剖标本可见置入ASD封堵器术后1月新生组织部分覆盖封堵器装置表面,术后3个月、6个月及9个月均已完全覆盖。与降解前的封堵器扇面直径比较,术后1个月、3个月及6个月均降低(P<0.05),且随时间延长降低明显,差异有统计学意义(P<0.05);与降解前的封堵器高度比较,除了术后1个月无明显差异(P>0.05),术后3个月、6个月均降低(P<0.05)。与降解前封堵器双盘面积比较,术后1个月、3个月、6个月及9个月均降低(P<0.05),且随时间延长降低明显,差异有统计学意义(P<0.05)。术后1个月、3个月封堵器周围组织炎症反应明显,在术后6个月、9个月消失;术后3个月及6个月血清IL-6浓度较术前升高(P<0.05),术后9个月降至正常(P>0.05),差异有统计学意义。结论:全生物可降解型ASD封堵器在猪ASD模型封堵技术成功率高,组织覆盖迅速,生物相容性与降解效果良好,是一种比较理想的可降解封堵器。Objective：To assess the efficacy, tissue coverage, degradation and bio-compatibility for closure of atrial septal defect（ASD） in an swine model. Methods：The model of ASD was built under echocardiography＇s guidance after thoracotomy. Fifteen swines were involved and all swines were sacrificed at 1,3,6,9 months after surgery. Doppler echocardiography was used to observe efficacy and measure diameter of occluder disc.Gross anatomy was done to assess tissue coverage and degration. Hematoxylin-eosin staining was done to observe inflammatory reaction. ELISA was used to test the level of IL-6. Results ：Except 3 swines died of modeling, 12 swines with ASD were built successfully and implanted with biodegradable ASD occluders.No infection or shedding of occluder was observed intra-operative and post-operative. Occluders were placed well and no residual shunt was observed by doppler echocardiography. Occluders＇ surface was partly covered with neointima by gross anatomy at 1 month after surgery,while totally covered at 3,6,9 months. Compared with that of pre-operation, diameter of occluder disc decreased at 1,3,6 months after surgery（P〈0.05） and decreased significantly with the extension of time（P〈0.05 ） ; compared with that of pre-operation, occluders ＇ height decreased at 3 months, 6 months after surgery（P〈0.05）,however,there was little change at 1 month after surgery（P〉0.05）. Compared with that pre-opera- tion, double disc area of occluder decreased at 1,3,6,9 months after surgery（P〈O.05） and decreased significantly with the extension of time （P〈0.05）. Compared with that pre-operation, serum IL-6 level increased at 3 months and 6 months （P〈0.05）, and declined to normal at 9 months after surgery（P〉0.05）. Conclusion：With satisfactory effectiveness, bio-compatibility and degradation,the fully biodegradable ASD occluder is ideal for swine model of ASD.

关 键 词：封堵器 生物可降解 房间隔缺损 聚乳酸 猪 

分 类 号：R725.4[医药卫生—儿科]