摘要
目的观察两种止血夹在不同夹闭力下对血管内膜的损伤情况,并优化及验证最小夹闭力(MOF)计算公式,为临床选择合适的止血夹降低血管损伤提供理论依据。方法将96只体重280~300 g雄性SD大鼠(山西医科大学动物实验中心)通过随机数字表法分为金属止血夹组(n=48)和一次性止血夹组(n=48),每组内均包含夹闭力为0.3、0.6、0.9、1.2 N 4个亚组进行腹主动脉的损伤实验,通过扫描电镜观察血管内膜的损伤情况。建立血管闭合模型进行数学分析,推出血管理论MOF的计算公式。根据血压(BP)、血管直径(D)及止血夹宽度(W),将理论MOF与实际MOF两组数据均值进行配对t检验分析,验证公式的准确性。纳入2021年1月至2022年12月因口腔颌面部恶性肿瘤就诊于山西医科大学口腔医学院·口腔医院口腔颌面外科的患者6例(12条支动脉),验证MOF公式的准确性。结果扫描电镜下观察,在夹闭力为0.3 N时,一次性止血夹对血管内膜损伤非常小(1级损伤),仅有部分皱襞被压平的表现。当夹闭力为0.6 N时,两种止血夹均引起了内膜表面的部分剥脱(2~3级损伤)。当夹闭力调整到0.9、1.2 N时,两种止血夹损伤均较严重(3~4级损伤),内膜大面积剥脱甚至消失,金属止血夹组的部分标本出现了肌层损伤的表现。通过血管闭合模型分析得出公式MOF=2×(1/2×π×D×W×BP),24只SD大鼠腹主动脉直径为(1.41±0.07)mm,血压(83.29±11.56)mmHg(1 mmHg=0.133 kPa);理论MOF值[(0.096±0.015)g]与实际最小夹闭力值[(0.095±0.012)N]差异无统计学意义(t=-0.35,P=0.725)。在临床应用中,6例患者的12支动脉应用MOF计算公式选择合适的止血夹成功阻血,验证了公式的准确性。结论止血夹可对血管内膜造成损伤,夹闭力越大,损伤程度越大;一次性止血夹避免血管内膜过度损伤具有优势;理论MOF计算公式具有一定的可靠性,可将其作为参考来选用合适的止血夹降低损伤。
ObjectiveTo explore the intimal injury of two kinds of hemostatic clips under different clamping forces,and to optimize and verify the calculation formula of minimum occlusion force(MOF),so as to provide theoretical basis for selecting appropriate hemostatic clips to reduce vascular injury.MethodsA total of 96 male SD rats with body weight ranging from 280 to 300 g(Animal Experimental Center of Shanxi Medical University)were randomly assigned to metal hemostatic clip group(n=48)and disposable hemostatic clip group(n=48)by random number table method.Each group was further divided into four subgroups with clamping forces of 0.3,0.6,0.9 and 1.2 N for abdominal aortic injury experiments.The damage to the vascular intima was observed under a scanning electron microscope.A vascular closure model was established for mathematical analysis to derive the theoretical calculation formula of the arterial blood management factor(MOF).According to blood pressure(BP),blood vessel diameter(D)and hemostatic clamp width(W),the average values of theoretical and actual MOF data were analyzed by paired t test to verify the accuracy of the formula.From January 2021 to December 2022,six patients(with 12 branch arteries)who presented with oral and maxillofacial malignancies at the Department of Oral and Maxillofacial Surgery,Shanxi Medical University School and Hospital of Stomatology,were included to validate the accuracy of the MOF formula.ResultsUnder electron microscopy,when the clamping force was 0.3 N,the one-time hemostatic clip caused very little damage to the vascular intima(grade 1 injury),with only a few folds being flattened.When the clamping force was 0.6 N,both types of hemostatic clips caused partial peeling of the intima surface(grade 2-3 injury).However,when the clamping force was adjusted to 0.9 and 1.2 N,the damage caused by both types of hemostatic clips was more severe(grade 3-4 injury),with large areas of intima peeling or even disappearance.In some specimens of the metal hemostatic clip group,the damage even reached the muscular layer.Vascular closure model analysis showed that MOF=2×(1/2×π×D×W×BP),the mean diameter of abdominal aorta of 24 SD rats was(1.41±0.07)mm,the blood pressure was(83.29±11.56)mmHg(1 mmHg=0.133 kPa).The theoretical MOF value was(0.096±0.015)N,the actual clamping force(ACF)was(0.095±0.012)N,there was no statistical significance between the two groups(t=-0.35,P=0.725).In clinical application,the MOF calculation formula was used to select the appropriate hemostatic clip for 12 arteries,successfully blocking the blood flow,verifying the accuracy of the formula.ConclusionsHemostatic clips can cause damage to the inner membrane of blood vessels,and the greater the clamping force,the more severe the damage.Disposable hemostatic clips have certain advantages in avoiding excessive damage to the inner membrane of blood vessels.The theoretical MOF calculation formula has a certain degree of reliability and can be used as a reference to select the appropriate hemostatic clip with low damage.
作者
任立志
王倩倩
王丹
张泽鹏
武晓芬
孙睿
Ren Lizhi;Wang Qianqian;Wang Dan;Zhang Zepeng;Wu Xiaofen;Sun Rui(Department of Stomatology,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Third Hospital of Shanxi Medical University,Taiyuan 030032,China;Department of Periodontology,Shanxi Medical University School and Hospital of Stomatology,Taiyuan 030000,China;Department of General Dentistry,Shanxi Medical University School and Hospital of Stomatology,Taiyuan 030000,China;Department of Stomatology,Wenshui County People's Hospital of Shanxi Province,Wenshui 032100,China)
出处
《中华口腔医学杂志》
北大核心
2025年第5期501-508,共8页
Chinese Journal of Stomatology
基金
山西省基础研究计划(202103021224378)
山西白求恩医院人才引进科研启动金项目(2022RC13)。
关键词
血管内膜
止血夹
损伤
最小夹闭力
显微镜检查
电子
扫描
Tunica intima
Haemostatic clip
Injury
Minimal clamping force
Microscopy,electron,scanning
作者简介
通信作者:孙睿,Email:ruidoctor@163.com,电话:0351-4960227。
