中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (21): 3394-3400.doi: 10.12307/2022.650

• 材料生物相容性 material biocompatibility • 上一篇    下一篇

改良Blalock-Taussig分流术中应用膨体聚四氟乙烯人工血管的效果与组织相容性分析

周世成1，韩宏光2，季  芳3，徐莉莹2，张晓慧2，孙  畅2   

  1. 1中国医科大学北部战区总医院研究生培养基地，辽宁省沈阳市  110016；北部战区总医院，2心血管外科，3医疗管理科，辽宁省沈阳市  110016
  • 收稿日期:2021-10-12 接受日期:2021-11-19 出版日期:2022-07-28 发布日期:2022-01-28
  • 通讯作者: 韩宏光，博士，主任医师，硕士生导师，北部战区总医院心血管外科，辽宁省沈阳市 110016
  • 作者简介:周世成，男，1994年生，辽宁省丹东市人，汉族，中国医科大学在读硕士，医师，现规培于北部战区总医院，主要从事心血管外科疾病基础与临床的研究。
  • 基金资助:
    2020年度沈阳市科学技术计划项目(20-205-4-016)，项目负责人：韩宏光；军队医学科技青年培育计划立项拔尖项目(20QNPY090)，项目负责人：韩宏光

Effect and histocompatibility of expended polytetrafluoroethylene in modified Blalock-Taussig shunt

Zhou Shicheng1, Han Hongguang2, Ji Fang3, Xu Liying2, Zhang Xiaohui2, Sun Chang2   

  1. 1Graduate School, General Hospital of Northern Theater Command, China Medical University, Shenyang 110016, Liaoning Province, China; 2Department of Cardiovascular Surgery, 3Medical Management Division, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
  • Received:2021-10-12 Accepted:2021-11-19 Online:2022-07-28 Published:2022-01-28
  • Contact: Han Hongguang, MD, Chief physician, Master’s supervisor, Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
  • About author:Zhou Shicheng, Master candidate, Physician, Graduate School, General Hospital of Northern Theater Command, China Medical University, Shenyang 110016, Liaoning Province, China
  • Supported by:
    The 2020 Shenyang Science and Technology Plan Project, No. 20-205-4-016 (to HHG); the Top-Notch Military Medical Science and Technology Youth Training Program, No. 20QNPY090 (to HHG)

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摘要：

文题释义：
膨体聚四氟乙烯人工血管：膨体聚四氟乙烯微孔膜因具有耐高温、抗酸碱、耐溶剂性等良好的生物兼容性特性，拓展了其在医疗方面的应用。在外科手术中，人工血管主要用于暂时性或永久性的血管替代物或作为动脉阻塞时的分流通道，以及需要血液透析的肾病患者的动静脉移植替代物。目前，膨体聚四氟乙烯合成的人工血管已被广泛应用于组织修复、血管重建中。
改良Blalock-Taussing分流手术：在1945年由ALFRED BLALOCK和HELEN TAUSSING首先提出并应用于临床，此后该手术方法得到不断改进与发展。部分紫绀型复杂先天性心脏病患者无法获得一期根治治疗时，则采用改良Blalock-Taussing分流手术应用人工管道建立锁骨下动脉和肺动脉的交通，为根治术的实施创造有利条件。

背景：改良Blalock-Taussig分流手术被普遍应用于严重的紫绀型先天性心脏病，该手术需要根据解剖结构及心肺发育的情况建立新的心内外血液循环通路，此时合适的血管替代物不可或缺。
目的：评价膨体聚四氟乙烯人工血管在改良Blalock-Taussig分流术中的应用效果与组织相容性。
方法：选择2009年6月至2019年12月北部战区总医院收治的复杂性先天性心脏病患者62例，年龄3个月至15岁，均采用膨体聚四氟乙烯人工血管进行改良Blalock-Taussig分流手术。根据住院及随访期间是否发生死亡分组，存活组57例，死亡组5例，对比两组并发症发生情况，采用二元Logistic回归分析造成死亡的危险因素；对于存活者，随访观察膨体聚四氟乙烯人工血管的组织相容性。
结果与结论：①62例患者术毕SaO2即刻升高至80%以上，紫绀显著改善，术中发生严重低心排出量综合征和心律失常8例(12.9%)，其中死亡组5例均为围术期死亡，其余57例患者均完成术后1年随访；两组术后早期的床旁透析、血红蛋白尿、灌注肺发生情况比较差异有显著性意义(P < 0.05)；②二元Logistic回归分析显示，患者低体质量、术中严重低心排出量综合征是改良Blalock-Taussig分流术后患者死亡的危险因素(P < 0.05)；③随访期间，改良Blalock-Taussig分流手术改善了患者左心室和肺动脉发育，无人工管道断裂或撕脱、溶血、排斥反应、非结构性功能障碍及结构性损伤等生物学和解剖学不良反应发生；④结果提示，改良Blalock-Taussig分流手术治疗复杂性先天性心脏病可明显缓解症状，促进左心室与肺动脉发育，术中应用的膨体聚四氟乙烯人工血管具有良好的短期组织相容性。

https://orcid.org/0000-0003-2647-0572 (周世成) 

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

关键词: 先天性心脏病, 改良Blalock-Taussing分流术, 生物材料, 膨体聚四氟乙烯, 人工血管, 组织相容性, 姑息性手术, 危险因素

Abstract: BACKGROUND: Modified Blalock-Taussig shunt surgery is commonly used in severe cyanotic congenital heart disease. This surgery requires the establishment of new internal and external blood circulation pathways based on the anatomy and the development of the heart and lungs. At this time, a suitable blood vessel replacement is indispensable. 
OBJECTIVE: To evaluate the effect and histocompatibility of expended polytetrafluoroethylene in modified Blalock-Taussig shunt.
METHODS: Totally 62 patients who were diagnosed with congenital heart disease and underwent a modified Blalock-Taussig shunt with expended polytetrafluoroethylene vessels at the age of 3 months-15 years were admitted from June 2009 to December 2019 in the General Hospital of Northern Theater Command. According to whether death occurred during hospitalization and follow-up, 57 cases were in the survival group and 5 cases were in the death group. The occurrence of complications was compared between the two groups. Binary logistic regression was used to analyze the risk factors of death. For the survivors, follow-up was performed to observe the histocompatibility of the expended polytetrafluoroethylene artificial vessel. 
RESULTS AND CONCLUSION: (1) Postoperative SaO2 in patients increased immediately to above 80% with cyanosis alleviated significantly. Severe hypotension and arrhythmias occurred during the surgery in 8 patients (12.9%), 5 of which died in the perioperative phase in the death group. All the remaining 57 patients were followed up for one year. There were significant differences in the early postoperative bedside dialysis, hemoglobinuria, and perfusion lung between the two groups (P < 0.05). (2) Binary logistic regression analysis showed that low weight and severe low cardiac output during the surgery were risk factors for postoperative death after modified Blalock-Taussig shunt (P < 0.05). (3) During follow-up, the modified Blalock-Taussig shunt improved the development of the left ventricle and pulmonary artery. There was no occurrence of biological and anatomical adverse consequences like artificial conduit rupture or avulsion, hemolysis, rejection, nonstructural dysfunction, or structural injury. (4) The results show that Blalock-Taussing shunt for complex congenital heart disease can significantly relieve symptoms and promote the development of the left ventricle and pulmonary artery. The expended polytetrafluoroethylene has good short-term histocompatibility. 

Key words: congenital heart disease, modified Blalock-Taussing shunt, biomaterials, expended polytetrafluoroethylene, artificial blood vessels, histocompatibility, palliative surgery, risk factors

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