显微外科血管吻合术局部注射罂粟碱后创面有形物质形成原因的探讨及预防

Study on the mechanism of wound crystal formation after local injection of papaverine in microvascular anastomosis

目的探讨显微外科血管吻合术局部注射罂粟碱后创面形成有形物质的原因及预防方法。方法模拟术中条件,于35℃室温下将不同浓度罂粟碱分别与常用浓度肝素钠及血清混合,观察有形物质形成条件,实验分为高浓度罂粟碱组(10 mg/mL)、对照组(0.9%生理盐水)、低浓度罂粟碱组(1 mg/mL)。分别于高浓度罂粟碱组试管A内加入肝素钠(25 U/mL)2.0 mL+罂粟碱(10 mg/mL)0.1 mL;试管B内加入新鲜人血清2.0 mL+罂粟碱(10 mg/mL)0.1 mL;试管C内加入肝素钠(25 U/mL)1.0 mL+新鲜人血清1.0 mL+罂粟碱(10 mg/mL)0.1 mL;对照组:试管D内加入生理盐水0.1 mL+新鲜人血清2.0 mL;低浓度罂粟碱组:试管E内加入肝素钠(25 U/mL)2.0 mL+罂粟碱(1 mg/mL)0.1 mL;试管F内加入新鲜人血清2.0 mL+罂粟碱(1 mg/mL)0.1 mL;试管G内加入肝素钠(25 U/mL)1.0 mL+新鲜人血清1.0 mL+罂粟碱(1 mg/mL)0.1 mL。结果高浓度罂粟碱组:A试管内加入罂粟碱后立刻出现淡蓝色透明流体样沉淀物,沉淀物沉积于试管底部,密度均匀,震荡后溶解;B试管内加入罂粟碱后立即在血清上部出现乳白色絮状漂浮物,离心后可分离大量结晶;C试管内加入罂粟碱后立即在液平面出现乳白色絮状漂浮物,离心后无结晶形成。对照组:D试管内加入生理盐水后无明显反应。低浓度罂粟碱组:E试管内加入罂粟碱后立即产生少量蓝色透明胶体样沉淀物,随即溶解;F试管内加入罂粟碱后液平面产生少量白色絮状漂浮物,随即缓慢溶解,无结晶形成;G试管内加入罂粟碱后无明显反应。结论高浓度罂粟碱(10 mg/mL)与血清结合早期可产生乳白色絮状漂浮物,离心后产生羽状结晶,结晶的产生与罂粟碱浓度有关,显微外科手术中创面周围注射罂粟碱前后生理盐水冲洗或使用低浓度罂粟碱(1 mg/mL)可预防沉淀物产生,避免血管吻合手术失败风险。

Objective To investigate the reasons and preventive methods of deposit formation after local injection of papaverine in vascular anastomosis.Methods The experiment was divided into high concentration papaverine group(10 mg/mL),control group(0.9%normal saline),low concentration papaverine group(1 mg/mL);In the high concentration papaverine group,2.0 mL heparin(25 U/mL)and 0.1 mL papaverine(10 mg/mL)were added into tube A;In tube B,2.0 mL fresh human serum and 0.1 mL papaverine(10 mg/mL)were added;1.0 mL heparin sodium(25 U/mL),1.0 mL fresh human serum and 0.1 mL papaverine(10 mg/mL)were added into tube C;Control group:0.1 mL normal saline and 2.0 mL fresh human serum were added into tube D;Low concentration papaverine group:heparin sodium(25 U/mL)2.0 mL+papaverine(1 mg/mL)0.1 mLwere added into tube E;Added 2.0 mL fresh human serum and 0.1 mL papaverine(1 mg/mL)into test tube F;1.0 mL heparin sodium(25 U/mL),1.0 mL fresh human serum and 0.1 mL papaverine(1 mg/mL)were added into tube G.Results In the high concentration papaverine group:A,after papaverine was added into the test tube,a light blue transparent fluid like precipitate appeared immediately,and the precipitate deposited at the bottom of the test tube with uniform density and dissolved after shaking.B.after papaverine was added into the test tube,milky flocculent floating substance appeared immediately in the upper part of serum,and a large number of crystals could be separated after centrifugation.After papaverine was added into c test tube,milky flocculent floating matter appeared on the liquid surface immediately,and a small amount of crystals were separated by centrifugation.Control group:there was no obvious reaction in D test tube after adding normal saline.Low concentration papaverine group:after papaverine was added into E test tube,a small amount of blue transparent colloidal precipitate was produced immediately and dissolved immediately.After papaverine was added into F test tube,a small amount of white flocculent floating substance was produced on the liquid surface,then slowly dissolved and micro crystals were separated.There was no obvious reaction after papaverine was added into G test tube.Conclusion High concentration papaverine(10 mg/mL)combined with serum can produce milky flocculent floating matter in the early stage,and produce pinnate crystals after centrifugation.The formation of crystals is related to the concentration of papaverine.Normal saline flushing or low concentration papaverine(1 mg/mL)before and after papaverine injection around the wound can prevent the formation of precipitates and avoid the risk of failure of vascular anastomosis.