利百素凝胶对留置针输注高渗溶液静脉超微结构的影响

Influences of reparil-gel N on ultrastructure of vein as an approach to infuse hyperosmotic solution

目的：观察利百素凝胶对静脉留置针输注高渗溶液血管的损伤及其超微结构影响。方法：成年新西兰兔的耳缘静脉随机分为对照组、凝胶组和凝胶加温组。3组均静脉推注20％甘露醇溶液。凝胶组在穿刺点近心端涂利百素凝胶；凝胶加温组在凝胶组的基础上将液体加温至35℃～37℃。用药2d后观察输液部位，并留取3组静脉标本，观察其形态 学和超微结构变化。结果：凝胶组和凝胶加温组静脉损伤程度差异无统计学意义，但两者较对照组差异有统计学意义。电镜下观察对照组血管内皮细胞胞膜脱落，线粒体水肿、空泡化。凝胶组血管内皮层缺失，部分线粒体模糊，细胞间质轻度水肿。凝胶加温组线粒体嵴清晰，细胞问质轻度水肿，吞噬小泡功能完整。结论：利百素凝胶外用可预防或减轻静脉炎的发生；将甘露醇溶液加温并外涂利百素凝胶联合干预效果更佳。

Objective：To explore whether reparil-gel N protects vein against injury caused by infusion of hyperosmotic solution by detecting the vein ultrastructure. Methods： 20% mannitol solution was intravenous injected into 24 auricular veins of 12 adult New Zealand rabbits, which were randomly grouped according to different treatment. Before injection, the proximal part of injection point coated with a thin layer of reparil-gel N was used as gel group. Additional beating of mannitol solution to 35-37℃ to gel coating was defined as gel＋heating group. And only intravenous injection of 20% mannitol solution was defined as control. Two clays after injection, the incidence of phlebitis was graded according to criterion established by Intra venous Nurses Society, and the morphology and ultrastructure of veins were observed. Results： Compared with that in control, the incidences of phlebitis were statistically decreased in gel and gel ＋ heating groups, while no significant difference was found between those two groups. The electron micrographs showed that the cell membrane of endothelial cells were lost; and the edema and vacuolization of the mitochondria was found in the control group. Application of reparil-gel N led to defective endothelium, vague mitochondria and slightly swelled intercellular matrix. Additional heating of mannitol solution caused clear mitoehondria, slight swelling of the intercellular substance and physiological function of phagocytes. Conclusion： Reparil-gel N can prevent or reduce the incidence of phlebitis. The concerted intervention, coated with a thin layer reparil gel N and heated mannitol solution may produce a better effect.