合成α-氰基丙烯酸正丁酯医用胶用于肝脏止血  

A chemosynthetic medical adhesive containing alpha-N butyl cyanoacrylate for liver hemostasis

作　　者：张飞 赵君[2] 孟兴凯[3] 李剑锋[2] 

机构地区：[1]内蒙古自治区人民医院普外科,内蒙古自治区呼和浩特市010020 [2]内蒙古医科大学第二附属医院康复科,内蒙古自治区呼和浩特市010050 [3]内蒙古医科大学附属医院普外科,内蒙古自治区呼和浩特市010010

出　　处：《中国组织工程研究》2016年第47期7112-7118,共7页Chinese Journal of Tissue Engineering Research

基　　金：内蒙古自治区自然科学基金面上项目(2015MS0898)~~

摘　　要：背景:目前医用胶主要分化学合成医用胶及生物医用胶,化学合成医用胶主要成分为α-氰基丙烯酸酯,亲水性差,易形成胶痂脱落,止血不彻底。目的:合成α-氰基丙烯酸正丁酯并改进其黏结效果,通过白兔肝脏止血实验验证其改性后的止血、黏接效果等相关性能。方法:(1)材料改良:制得α-氰基丙烯酸酯单体,通过红外波谱和气象色谱分析其组成和含量,合成α-氰基丙烯酸正丁酯。选用月桂酰肌氨酸钠作为表面活性剂,改进α-氰基丙烯酸正丁酯与组织脏器的结合效果,使其亲水性增强;(2)兔肝脏切口止血实验:分为3组,对照组在可吸收线缝合止血后覆盖明胶海绵,α-氰基丙烯酸酯医用胶组涂抹α-氰基丙烯酸酯医用胶,α-氰基丙烯酸正丁酯组涂抹合成及改性后的医用胶,在手术20 min内记录肝出血量和出血时间;(3)兔肝脏断面止血实验:分成2组,α-氰基丙烯酸正丁酯组在肝创面涂抹表面活性剂后,再涂合成的α-氰基丙烯酸正丁酯;α-氰基丙烯酸酯创面涂抹α-氰基丙烯酸酯医用胶。术后1,10和20 d通过肉眼观察肝创面胶层变化、与大网膜黏连情况等,再通过苏木精-伊红染色观察组织学变化。结果与结论:(1)改性后的α-氰基丙烯酸正丁酯医用胶有很好的黏结性,通过红外波谱和气象色谱分析,主要成分为α-氰基丙烯酸正丁酯,纯度为84.56%,其余含量较多的为反应物及生成的副产品,为8.2%和3.3%;(2)通过对兔肝脏切面出血量和出血时间比较,改性后的医用胶在出血量和出血时间上明显少于对照组(P<0.01),与α-氰基丙烯酸酯医用胶组差异无显著性意义(P>0.05);(3)改性后的医用胶胶层与肝创面结合更紧密,在术后20 d完全吸收,且未见到不良反应;(4)结果提示,改性后的α-氰基丙烯酸正丁酯医用胶黏接效果优于常规针线缝合,胶膜不易脱落,止血较彻底,无不良反应。BACKGROUND：There are chemosynthetic and biological medical adhesives, and the former mainly composed by cyanoacrylate, holds poor hydrophilicity and is easy to break off, thereby achieving unsatisfactory hemostatic effect. OBJECTIVE：To evaluate the hemostatic and adhesion effect of the modifiedα-N butyl cyanoacrylate （NBCA） by the hemostatic test in white rabbit livers. METHODS：Material imprvement：cyanoacrylate monomer was prepared and its components and contents were analyzed by infrared spectrum and gas chromatograph. Sodium lauroyl sarcosinate was used as surfactant to improve the cohesive force between NBCA and tissues and increase the hydrophility. Hemostatic test in the liver incision：the liver incision of rabbits in three groups were sewn with absorbable suture and then covered with gelatin sponge （control group）, cyanoacrylate and NBCA medical adhesives, respectively. Blood loss and bleeding time were recorded within 20 minutes. Hemostatic test in the liver section：the liver sections in two groups were smeared with surfactant plus NBCA and cyanoacrylate, respectively. The gross appearance of wound and its adherence to the omentum majus, as wel as the histological changes by hematoxylin-eosin staining were observed at 1, 10 and 20 days postoperatively. RSULTS AND CONCLUSIPON：The adhesiveness of NBCA medical adhesive was excel ent. Infrared spectrum and gas chromatograph found that the main component was NBCA up to 84.56%, with 8.2%reactants and 3.3%byproducts. The modified NBCA medical adhesive significantly decreased the blood loss and bleeding time compared with the control group （P〈0.01）, and did not significantly differ from the cyanoacrylate （P〉0.05）. In addition, the modified NBCA adhered more firmly to the wound, and was absorbed completely at 20 days postoperatively, showing no adverse reaction. These results suggest that NBCA is better and more stable than gelatin sponge, and exerts overt hemostatic effect causing no adverse reaction.

关 键 词：生物材料 材料相容性 改良 Α-氰基丙烯酸正丁酯 Α-氰基丙烯酸酯 肝脏止血 内蒙古自治区自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]