支树迪,袁坤山,张海军.心血管系统植入物抗菌表面的研究进展[J].表面技术,2025,54(6):47-61.
ZHI Shudi,YUAN Kunshan,ZHANG Haijun.Research Progress of Antibacterial Surfaces in Cardiovascular System Implants[J].Surface Technology,2025,54(6):47-61 |
| 心血管系统植入物抗菌表面的研究进展 |
| Research Progress of Antibacterial Surfaces in Cardiovascular System Implants |
| 投稿时间：2024-08-14 修订日期：2024-10-29 |
| DOI：10.16490/j.cnki.issn.1001-3660.2025.06.004 |
| 中文关键词: 心血管植入物 抗菌表面 pH响应释放 可再生抗菌 |
| 英文关键词:cardiovascular system implants antimicrobial surface pH-responsive release renewable antibacterial |
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| Author | Institution |
| ZHI Shudi | National-Local United Engineering Laboratory for Biomedical Material Modification Technology, Shandong Dezhou 251100, China;The Institute of Interventional and Vascular, Tongji University, Shanghai 200072, China |
| YUAN Kunshan | National-Local United Engineering Laboratory for Biomedical Material Modification Technology, Shandong Dezhou 251100, China;The Institute of Interventional and Vascular, Tongji University, Shanghai 200072, China |
| ZHANG Haijun | National-Local United Engineering Laboratory for Biomedical Material Modification Technology, Shandong Dezhou 251100, China;The Institute of Interventional and Vascular, Tongji University, Shanghai 200072, China |
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| 中文摘要: |
| 心血管系统植入物长期留置在人体与循环血液接触，在围手术期及留置期间均面临感染风险，极大地威胁着患者的生命安全。细菌在植入物上的黏附和繁殖是植入物引起心血管组织感染的主要原因。赋予心血管系统植入物抗菌功能可有效降低细菌感染发生概率，保障患者生存状态。随着抗菌表面的研究发展，出现了防黏附和杀菌两大类抗菌表面。防黏附表面不含杀菌活性物质，因此很少单独用于抗菌。主要从释放型抗菌、接触型抗菌和可再生型抗菌三方面介绍了杀菌型抗菌表面。释放型抗菌表面主要包含抗生素抗菌、金属粒子抗菌、NO抗菌和pH控释涂层以及4种表面的抗菌机理;接触型抗菌表面主要包含季铵盐抗菌、壳聚糖抗菌和抗菌肽抗菌及其抗菌机理;针对现有的抗菌表面难以避免被细菌残片污染的情况，介绍了可再生抗菌表面，该方法受启发于爬行动物的蜕皮行为，通过牺牲多层结构中的夹层，带走因细菌污染丧失抗菌功能的顶层，裸露出新的抗菌功能表面，实现抗菌表面再生，为长期抗菌功能构建提供了方向。最后，指出了当前心血管系统植入物抗菌功能表面存在的缺陷，并对未来进行了展望。 |
| 英文摘要: |
| The cardiovascular system is a closed tube system consisting of heart and blood vessels. Cardiovascular system implants (CSI) are medical devices that are surgically implanted or interventional and left in the cardiovascular system for a long period (greater than 30 days), including cardiac implantable electronic devices, stents, vascular grafts and catheters. Improper aseptic procedures during surgery or improper care during indentation may cause bacteria to enter the blood circulation system, adhere to and multiply on the surface of the cardiovascular system implant. Usually, the surface of cardiovascular system implants has no antibacterial function. Once bacteria colonize and form biofilms on its surface, it will threaten the life safety of patients. Building antibacterial functions on the surface of cardiovascular system implants can effectively reduce the probability of bacterial infection and ensure the survival of patients. With the development of antibacterial surface research, there are two kinds of antibacterial strategies:anti-adhesion and bactericidal. The anti-adhesion surface does not contain bactericidal active substances, so it is rarely used for antibacterial purposes alone. In this paper, the bactericidal antibacterial surface modification of cardiovascular system implants in recent years is reviewed, mainly from three aspects:release antibacterial, contact antibacterial and regenerative antibacterial. The release antibacterial strategy is generally to kill bacteria on and around the device surface by releasing bactericidal substances in the coating. Common released antibacterial substances include antibiotics, metal particles and NO antibiotics. The antibacterial effect of releasing antibacterial strategy is affected by the release concentration of antibacterial substances, high release concentration, short antibacterial aging, low release concentration and poor antibacterial effect. Unplanned release of antimicrobial substances not only shortens antibacterial aging, but also may cause the generation of drug-resistant strains. Therefore, this paper also describes the construction of responsive controlled release surface, with emphasis on pH-responsive release coatings. Most of the pH-responsive release coatings studied at present accelerate the release of antimicrobial substances in acidic environments, because the local pH value is reduced after infection. The contact type antibacterial surface is to fix bactericidal active substances on the material surface through physical or chemical methods to kill the bacteria on the instrument surface. Common contact bactericidal active substances include quaternary ammonium salts, chitosan and antimicrobial peptides. These three bactericidal active substances all kill bacteria through electrostatic action, so their surfaces are highly susceptible to bacterial debris contamination. In fact, both bactericidal antibacterial surfaces and anti-adhesion antibacterial surfaces are easy to be covered by protein due to human rejection reaction, and lose antibacterial function. To solve this problem, this paper introduces the renewable antibacterial surface. The method is inspired by reptile molting behavior and a multi-layer antibacterial coating is designed. The antibacterial coating is alternately coated by a functional layer and a sacrificial layer. Through the dissolution or degradation of the sacrificial layer, the lost antibacterial function of the top layer is decayed, the new antibacterial surface is exposed, and the antibacterial surface is regenerated, providing a direction for long-term antibacterial function construction. Finally, the surface defects of antibacterial function of cardiovascular system implants are pointed out and the future is prospected. |
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