摘要目的 探讨透明质酸血管栓塞后针刺出血治疗的安全性和效果.方法 取新西兰兔耳30只,在兔耳耳郭动脉内注射透明质酸填充剂,形成动脉栓塞模型.将兔耳模型随机分为针刺出血组、透明质酸酶组、未处理组3组并进行相应处理.对3组兔耳进行外观观察、坏死面积测量、组织学检查.结果 针刺出血组针刺后,针眼位置出现微量的透明质酸溢出,在接近血管的针刺点出现点状出血甚至大量出血并引发血肿.组织切片显示,针刺出血组1d后耳后中央动脉及远端分支动脉血管内仍充满透明质酸填充剂,周围组织出现坏死.12 d后,3组均出现耳尖和耳缘不同程度结痂坏死.未处理组、针刺出血组、透明质酸酶组结痂坏死面积分别是33.6％、22.0％、12.6％,透明质酸酶组和针刺放血组比较差异有统计学意义(t=0.013,P＜0.05).将近80％针刺出血组兔耳在针刺区域出现感染、瘀血等表现.结论 透明质酸动脉栓塞后,针刺出血组疗效不如透明质酸酶组,还会引起局部组织的改变.

abstractsObjective To investigate the safety and effect of bloodletting after hyaluronic acid embolization.Methods Rabbit ear auricle artery was chosen as a vascular model.After injection of hyaluronic acid,artery embolization was made.Rabbit ears were randomly divided into three groups,including bloodletting,hyaluronidase injection and untreated groups.We evaluated the effect through appearance observation and histological examination of the rabbit ears.Results During bloodletting,some points in acupuncture needles after extrusion appeared hyaluronic acid,some points even appeared massive hemorrhage and hematoma,but most points did not present any change.The histological examination showed the auricle artery was still full of hyaluronic acid,and the surrounding tissues showed necrosis after bloodletting.Long-term observation showed,after 12 days,all rabbits were alive,all of three groups presented scabby necrosis on the edge of ear.Scabby necrosis area ranked from large to small in untreated group (33.6 ％),bloodletting group (22.0％) and hyaluronidase injection group (12.6％) (t=0.013,P＜0.05);there was a statistical difference between the later two groups.At the same time,80％ of rabbit ears after bloodletting showed obvious color sink,infection or congestion.Conclusions After embolization of the hyaluronic acid artery,bloodletting is not as effective as hyaluronidase,and it would cause the adverse changes of local tissues.