The Comparison And Mechanism Of Pleurodesis Induced By Thrombin Or Talc Slurry

Objective :The pneumothorax and the Pleural effusion conservative treatment the main means are the pleurodesis, pours into the pleural adhesions agent to the pleural cavity, the cause inflammation that causes the visceral and the walls pleural adhesion, achieve the purpose of curing the disease. But each kinds of pleural adhesions agent has different effect, the mechanism to be further investigated. This experiment through pours into the talcum suspension liquid and the zymoplasm solution two kinds of pleural adhesions agent to New Zealand white rabbit pleural cavity, after the technique 4th, 7, 14 and 28 day of execution experimental animal, observes two kinds of pleural adhesions agent the adhesion effect, the inflammation response and the fibrosis degree, simultaneously discusses the pleural adhesion possible mechanism.Methods: Keeping the same level of 60 healthy New Zealand white rabbits, male, weighing 2 to 3kg, were randomly divided into A group (talc group 24), B group (thrombin 24), C group (control group 12 ).Sumianxin II, 0.4ml/kg intramuscular injection, anesthesia after the success of the limbs fixed in prone position in the experimental stage, select the left side of the chest as the experimental area, faded with the pet hair on the left chest wall to push shaving body hair, take the first×five rib axillary line between the intersection with the puncture points, respectively, with 2% tincture of iodine, 75% alcohol disinfection of the puncture area, using catheter needle puncture at the puncture point vertical, pull out the needle after the break parietal pleura core, no bleeding or aspiration syringe out of gas, identified as a successful puncture to the pleural cavity pleural adhesions were injected into two kinds of agents 5ml, and 1ml 0.9% NaCl solution with the washing operation completion pull out the catheter, the puncture point with gauze bandage, Will be placed in fixation after the rabbits Pinto 2, after turning back into the feeding room.Respectively, after the first 4d, 7d, 14d, 28d rabbits were killed to observe the situation and the parietal pleural adhesion pleural changes and pleural changes in description; observation of chest pleural cavity of water, its nature, color records; take experimental rabbit visceral pleura and the adjacent lung tissue and liver tissue, and 4% formaldehyde solution, fixed with hematoxylin - eosin (HE) staining the rule of law into a pathology, in the optical microscope observation of the lung and pleura organizations, the number of inflammatory cells and fibrosis , and ratings.Result :1 Two groups rabbit of the effect of pleural adhesion, inflammation, and fibrosis significantly different levels. Pleural adhesions Points: 4d when the talc group was a sub-total, five cases of a sub-thrombin group, and 1 0 minutes; 7d group when the talc group, 4 cases within 2 points, 2 cases of count 1 point; thrombin two cases of 2 hours, 4 cases of a sub; 14d when the talc group of four cases of four points, two cases of two points, three cases of three sub-thrombin group, 3 cases of 2 points; 28d when the talc group of three cases of four points, three cases of three sub - , thrombin group 1 cases of four points, five cases of 5 points.2 The degree of inflammation and fibrosis points:Talc group 4d alveolar damage, inflammatory cell count 4 points higher in 5 cases, 1 case within 3 points; 7d, when four cases of inflammatory cells decreased within 3 points, 2 cases of count 2 points; 14d fewer inflammatory cells in 4 cases when the total 2 points, 2 cases of count 1 point; 28d when the degree of pulmonary interstitial inflammation is very light, mainly in fibroblast-based. 4d alveolar thrombin no significant damage, moderate amount of inflammatory cells, 5 cases of total 3 hours, and 1 count 2 points; 7d inflammatory cells, when less than 2 points in 3 cases, 3 cases of count 1 point; 14d when the inflammation few cells, 6 patients were accrued 1 minute; 28d interstitial lung inflammation almost disappeared, there is a small number of lymphocytes, mainly in fibroblast-based.3 Pleural adhesion after 24 hours the amount of pleural effusion 4 d pleural cavity pleural effusion, 4 to 6ml, precipitation can be seen after the talc particles. 7d Group pleural cavity pleural effusion, 2 to 3ml, more clear, and precipitation can be seen after a small amount of fiber cord-like substance. 14d Group pleural cavity pleural effusion, 1 to 2ml, slightly viscous fluid will be placed in clean containers, can be seen more fiber cord-like substance. 28d Group pleural effusion less than 1ml, most of the pleural effusion had been absorbed.4 d pleural cavity pleural effusion, 3 to 4ml, precipitation can be seen after the talc particles. 7d Group pleural cavity pleural effusion, 1 to 2ml, the more clear, and precipitation can be seen after a small amount of fiber cord-like substance. 14d Group pleural cavity pleural effusion, 0.5ml, slightly viscous fluid will be placed in clean containers, can be seen more fiber cord-like substance. 28d group has been absorbed most of pleural effusion.Conclusion:1 Talcum powder injection of experimental animals, the 28th days pleural cavity with pleural cavity heart diaphragmatic Angle and side in the Angle of diaphragm pleural adhesions,2 Talcum powder injection experimental animals shall produce inflammation early pleural cavity, and gradually alleviate ceaselessly, pleural thickening,3 Talcum powder injection of experimental animals pleural cavity pro- duce Inflammatory pleural effusion,4 Talcum powder injection of experimental animals that without liver damage,5 Thrombin injection of experimental animals, the first 28 days pleural cavity with pleural cavity heart diaphragmatic Angle and side in the Angle of diaphragm pleural adhesions,6 Talcum powder injection experimental animals shall produce inflammation early pleural cavity, and gradually alleviate ceaselessly, pleural thickening,7 Thrombin infuse experimental animal pleural cavity produce Inflammatory pleural effusion,8 Thrombin injection of experimental animals that without liver damage,9 Talcum powder injection than thrombin solution of pleural adhesions pleural cavity with strong, early inflammatory reaction, but to terminal bronchial lung tissue damage to nearby. Both pleural adhesions on quantity belt without obvious difference, thrombin inflammatory reaction to the lungs, no damage, more applicable for clinical.