下腹部多个真皮下血管网皮瓣在手外伤修复中的应用

目的：应用下腹部多个真皮下血管网皮瓣修复手外伤，方法：在下腹形成以旋髂浅血管为蒂的髂腰部皮瓣及以腹壁浅血管为蒂的下腹部皮瓣，二皮瓣共蒂形成双叶皮瓣，同时将其修薄，形成有轴心血管的真皮下血管网皮瓣，修复两指完全脱套伤。在下腹部形成多个真皮下血管网的任意皮瓣，修复多个指背皮肤缺损伴有肌腱及骨外露的创面。供区如不能直接拉拢缝合，可取断层皮片修复供区创面.结果：本组10例中，8例采用下腹部双叶真皮下血管网轴型皮瓣修复，2例采用下腹部真皮下血管网任意皮瓣修复，术后效果。结论：采用多个真皮下血管网皮瓣修复手外伤的创面，伤指不需并指，去脂，分指，术后外形佳，是目前较理想的修复手外伤的手术方法。     

猪SVN皮瓣成活长度的实验研究

以１２只家猪为模型，形成真皮下血管网皮瓣（ＳＶＮ皮瓣）和筋膜皮瓣，共４８个，大小为７５ｃｍ×３ｃｍ。术后７天筋膜皮瓣成活长度为５．８ｃｍ，ＳＶＮ皮瓣的成活长度为８ｃｍ，较筋膜皮瓣增加了３８％，皮瓣远端愈合类似真皮下血管网皮片。此结果表明，ＳＶＮ皮瓣是超薄超长皮瓣和真皮下血管网皮片的联合体，并对此进行了讨论     

内皮素及NO在严重烧伤早期胃肠粘膜缺血中的作用

目的　采用３０ ％ Ｔ Ｂ Ｓ Ａ 烧伤小型猪模型,系统观察内皮素及一氧化氮（ Ｅ Ｔ／ Ｎ Ｏ） 在胃肠缺血中的作用,并通过应用 Ｎ Ｏ 供体 Ｃ８７３７５４ 对胃肠缺血防治机制进行探讨。方法　小型猪１８只,随机分为对照组（ Ｃ 组） 、烧伤组（ Ｂ 组） 及 Ｎ Ｏ 供体组（ Ｎ 组） 。 Ｃ 组只手术不致伤,其余各组伤后按 Ｐａｒｋｌａｎｄ 公式进行复苏。 Ｎ 组在复苏同时给予 Ｃ８７３７５４（００１２５ ｍｇ·ｋｇ － １ ·ｍｉｎ － １） 。结果　烧伤后 Ｂ 组在肠道血流量下降的同时,门脉血及肠道组织中的 Ｅ Ｔ 含量迅速升高,于伤后１ｈ 达到峰值,伤后７２ｈ 未能恢复到伤前水平;而同时 Ｎ Ｏ 含量呈相反变化,二者呈显著负相关。 Ｎ 组能使肠道血流量在伤后２４ｈ 内恢复较快,同时发现能升高门脉血及肠道组织内 Ｎ Ｏ 含量。 Ｎ Ｏ Ｓｄ Ｎ Ａ Ｄ Ｐ Ｈ 染色也发现肠组织内密度明显较 Ｂ 组增加。结论　①胃肠道血流量下降与 Ｅ Ｔ／ Ｎ Ｏ 变化有关。② Ｎ Ｏ 供体能通过释放 Ｎ Ｏ,有效地改善胃肠组织血流灌注,对防治胃肠缺血有积极意义。     

真皮下血管网皮瓣蒂部的作用

目的考察真皮下血管网皮瓣的蒂部作用。方法用健康、白色家猪的实验，按自身相互对照原则在动物躯干两侧分别设计真皮下血管网皮瓣、传统皮瓣动物模型。通过两组皮瓣成活过程的大体观察，及皮瓣ＥＣＴ检查核素分布情况的比较方法进行研究。结果真皮下血管网皮瓣成活长度、面积均值较传统皮瓣有显著差异（Ｐ＜０．０５）。ＥＣＴ检测示实验组与对照组核素分布均相似局限于近蒂端，长宽比为（１～１．５）∶１。结论真皮下血管网皮瓣蒂的作用与传统皮瓣相似，对其超长成活部分作了可能的解释。     

轴型动脉蒂真皮下血管网皮瓣在创伤修复中的应用

报道３９例轴型动脉蒂真皮下血管网皮瓣（ＳＶＮ皮瓣），修复四肢皮肤软组织缺损。直接皮动脉蒂ＳＶＮ皮瓣２３例，岛状ＳＶＮ皮瓣１３例，吻合血管的ＳＶＮ皮瓣３例。除１例吻合血管的ＳＶＮ皮瓣失败外，其余均成活。经６个月～１年随访，外形良好，不臃肿，无瘢痕增生，质地正常。这种皮瓣兼有轴型皮瓣和真皮下血管网皮瓣的优点，临床应用范围大，效果良好。     

傍轴型血管型与随意型的SVN薄皮瓣成活对比研究

目的：探讨不同类型真皮下血管网薄皮瓣成活的差别。方法：以5只小型猪为实验动物,分别于胸腰背部形成随意型、于骼腹部形成倍轴型血管型的真皮下血管网薄皮瓣,所有皮瓣长、宽、蒂宽、形状、手术操作均相同。术后第7天观察。结果：两种皮瓣坏死面积不同（P＜0．05）。结论：傍轴型血管型真皮下血管网薄皮瓣成活情况明显优于随意型者。     

真皮下血管网薄皮瓣血管构筑变化与成纤维细胞生长因…

为了探讨真皮下血管网薄皮瓣的成活机理，以兔为实验动物，在其背侧形成１５ｃｍ×３ｃｍ的真皮下血管网薄皮瓣，利用微循环显微镜，病理切片，组织化学染色等手段进行观察。结果表明真皮下血管网薄皮瓣术后远，中，近段血管构筑具有明显差别：近段同正常皮肤，中段为极度活跃的血管增生，远段为中度血管增长。     

异丙酚和哌氟合剂辅助连硬外阻滞下行胆囊切除术血浆内皮素？…

目的：观察异丙酚和哌氟合剂作为硬膜外辅助用药的临床效果及其对术中血浆内皮素（ＥＴ）和一氧化氮（ＮＯ）水平的影响。方法：２１例择期胆囊切除病人随机分为两组。麻醉完善后，Ⅰ组用微泵输注异丙酚２ｍｇ．ｋｇ＾－１．ｈ＾－１；Ⅱ组给于哌替啶５０ｍｇ静注。于麻醉前、麻醉后、牵拉胆囊及术终抽静脉血测定ＮＯ和ＥＴ的含量。结果：麻醉后两组病人ＢＰ、ＥＴ值均明显下降，ＮＯ值升高；牵拉胆囊及术终抽静脉血测定ＮＯ和ＥＴ的     

盐酸罂粟碱对任意皮瓣微循环影响的实验研究

目的:探讨局部使用盐酸罂粟碱对任意皮瓣微循环重建的影响.方法:设计大鼠背部3cm×10cm长方形任意皮瓣,蒂部皮下注射盐酸罂粟碱,观察术后变化.结果:存活率提高,差异有显著性.结论:①盐酸罂粟碱注射液能够诱导任意皮瓣真皮下血管网血管生成;②盐酸罂粟碱注射液能够改善任意皮瓣缺血再灌注损伤保护皮瓣内多种细胞,从而对皮瓣缺血再灌注损伤产生一定的保护作用.     

真皮下血管网薄皮瓣血运重建方式的实验研究

目的 探讨真皮下血管网薄皮瓣的成活机理。方法 分别在３组家兔背部形成真皮下血管网薄皮瓣、真皮下血管网皮片、传统随意皮瓣。运用组织透明技术,观察３组动物术后１～７ｄ、１４ｄ血管构筑变化的差异。结果 真皮下血管网薄皮瓣段存在一血管增生快速密集区－“中介蒂”,其血运重建过程明显早于传统随意皮瓣、真皮下血管网皮片。结论 本研究证实了“中介蒂”的存在,且这是真皮下血管网薄皮瓣可早期断蒂、有一定限度超长成活的     

Endothelin receptor blockade improves oxygenation in contralateral TRAM flap tissue in pigs.

Partial skin and fat necrosis is the most common complication occurring in TRAM flaps. It is related to disturbances of the microcirculation and oxygenation in the contralateral part of the flap. It may be hypothesised that the development of necrosis is promoted by the vasoconstrictor endothelin, the production of which is enhanced in ischaemic flap tissues. The purpose of this study was to evaluate the effect of tezosentan, a new endothelin receptor blocker, on microcirculation and oxygenation in experimental TRAM flaps. The administration of tezosentan began preoperatively (3 mg/kg body weight) and then continued at a rate of 1.5 mg/kg/h. A TRAM flap with a skin island measuring 16 x 8 cm was raised in the middle of the epigastrium in minipigs. The flap was pedicled on the right superior epigastric vessels. Microcirculatory blood flow was measured with laser Doppler flowmetry and tissue oxygen tension was measured with a Clark-type microprobe. Dominant subcutaneous veins were cannulated in both the ipsilateral and the contralateral parts of the flap. Subdermal tissue oxygen tension in the contralateral part of the flap was significantly reduced 4h after surgery to 5 mmHg (ca. 48 mmHg in normal tissue) in the control group, but to only 12 mmHg in the group that had been administered tezosentan (P< 0.05). Furthermore, tezosentan significantly attenuated venous hypertension (14 mmHg versus 24 mmHg), as well as lactate (4.0 mmol/l versus 5.6 mmol/l) and haemoglobin (10.2 g/dl versus 11.4 g/dl) concentrations in the venous effluent of the contralateral part of the flap, although microcirculatory blood flow remained virtually unchanged. Our findings suggest that tezosentan improves oxygenation and metabolism in the jeopardised contralateral flap tissue, probably as a result of a decrease in venous vascular resistance and fluid extravasation.     

早期肠道喂养改善烧伤后肠道血液灌流的实验研究

目的 探讨早期肠道喂养改善烧伤大鼠肠血液灌流的机理。方法 采用３０％体表面积Ⅲ度烧伤大鼠模型,分为正常对照（Ｃ）、单纯烧伤（Ｂ）和早期喂养（ＶＩＰ）含量及肠粘膜血流量（ＬＭＢＦ）。结果 烧伤后肠组织中ＥＴ、ＮＯ、ＶＩＰ及ＥＴ／ＶＩＰ比值均呈上升趋势,而ＩＭＢＦ则显著低于伤前。ＥＦ组中ＥＴ含量及ＥＴ／ＮＯ、ＥＴ／ＶＩＰ比值明显低于Ｂ组,而ＮＯ、ＶＩＰ及ＩＭＢＦ则高于Ｂ组,肠道喂养烧伤后肠道缺血状况的     

急性胰腺炎患者血浆内皮素和一氧化氮水平变化及其意义

目的：了解急性胰腺炎患者血浆内皮素（ＥＴ）和一氧化氮（ＮＯ）与胰腺微循环的关系。方法：采用放免法和反相高效液相色谱法,分别检测血浆总ＥＴ和ＮＯ的稳定代谢产物ＮＯ２＾－／ＮＯ３＾－,以ＮＯ２＾－／ＮＯ３＾－,以ＮＯ２＾－与ＮＯ３＾－之和代表ＮＯ水平。结果：治疗前ＥＴ和ＮＯ均增高,前者显著大于后者,ＥＴ／ＮＯ比值显著增大。治疗后各值随病情好转渐恢复正常。ＥＴ和ＮＯ呈正相关关系。结论：ＥＴ／ＮＯ比值失衡     

大鼠脑血管痉挛时血及脑组织NO、内皮素改变和银杏叶制剂的作用

目的　探讨 Ｎ Ｏ、内皮素（ Ｅ Ｔ） 与蛛网膜下腔出血（ Ｓ Ａ Ｈ） 后脑血管痉挛（ Ｃ Ｖ Ｓ） 的关系和银杏叶制剂（ Ｇ Ｂ Ｅ） 的防治作用。方法　对假手术组、单纯 Ｓ Ａ Ｈ 模型组和 Ｇ Ｂ Ｅ 处理组大鼠检测２４ 小时内局部脑血流量、血及脑组织 Ｎ Ｏ、 Ｅ Ｔ 含量,并测基底动脉管径及行海马病理检查。结果　 Ｓ Ａ Ｈ 造成局部脑血流量持续下降,并有基底动脉痉挛,海马 Ｃ Ａ１ 区神经元明显受损;血 Ｎ Ｏ 减少、 Ｅ Ｔ 增多,脑组织 Ｎ Ｏ、 Ｅ Ｔ 均增加; Ｇ Ｂ Ｅ 使上述改变均减轻。结论　血 Ｎ Ｏ 减少、 Ｅ Ｔ 增多促使 Ｓ Ａ Ｈ 后 Ｃ Ｖ Ｓ 发生,脑组织 Ｎ Ｏ 和 Ｅ Ｔ 增加加重脑损伤; Ｇ Ｂ Ｅ 通过逆转 Ｎ Ｏ、 Ｅ Ｔ 异常改变而发挥保护作用。     

颅内动脉瘤术后脑血管痉挛与血浆内皮素-1、一氧化氮含量的关系

目的　探讨内皮素 (ET) 1、一氧化氮 (NO)与颅内动脉瘤术后脑血管痉挛发生的关系。方法　颅内动脉瘤 3 0例 ,经颅多普勒 (TCD)检测脑血流速度 ,并抽取外周静脉血测定血浆ET 1和NO含量 ,进行手术前后对比研究。另选取 10例健康成人进行对比研究。结果　 (1)脑血管痉挛组术后 1～ 3d、5～ 7d血浆ET 1的平均含量明显高于同期未发脑血管痉挛组 (P <0 .0 1) ,与术前和正常组相比差异亦有显著性 (P <0 .0 1)。 (2 )脑血管痉挛组术后 1～ 3d血浆NO的平均含量明显低于术前 (P <0 .0 5 )和术后 5～ 7d(P <0 .0 1) ,术后 5～ 7d脑血管痉挛组的血浆NO平均含量明显高于未发生脑血管痉挛组和正常组 (P <0 .0 1)。结论　 (1)颅内动脉瘤术后脑血管痉挛的发生与血浆ET 1、NO平均含量呈明显相关性。 (2 )ET 1/NO在维持脑血管张力上起着重要作用 ,当两者动态平衡破坏时 ,可能导致脑血管痉挛发生。 (3 )对于术后血浆ET 1含量明显升高和 /或NO含量明显降低的患者应及时行经颅多普勒检查 ,有助于尽早发现脑血管痉挛 ,使脑缺血、脑梗死得到及时的预防和治疗     

一氧化氮和内皮素在肝脏再灌注损伤和缺血预处理中作用的研究

目的 :观察缺血预处理一氧化氮 (NO)和内皮素 (ET)的变化及其与再灌注损伤和微循环变化的关系。方法 :建立大鼠肝脏 70 %缺血再灌注损伤模型 ,分为对照组、缺血组、缺血预处理组、L 精氨酸组、L NAME组 ,观察各组肝功能变化 ,检测肝组织和血清中NO和ET及透明质酸 (HA)的水平 ,以HA代表肝脏微循环情况。结果 :再灌注损伤后微循环的破坏和NO和ET的变化相关 ,缺血预处理可减少NO水平的下降和血浆ET升高 ,减少微循环破坏和肝功酶的升高 (P <0 .0 5 )。外源性给予NO合成前体L 精氨酸在升高NO水平降低ET水平的同时 ,可达到类似预处理的保护作用。结论 :血管活性介质NO的减少和ET水平增加是导致再灌注损伤微循环变化的原因之一。缺血预处理可诱导增加NO和减少ET ,并可能是其改善微循环和减少再灌注损伤的因素之一。给予外源性NO可起到类似缺血预处理的保护效果 ,而抑制NO产生并不能加重再灌注损伤。     

The endothelin receptor antagonist tezosentan improves renal microcirculation in a porcine model of endotoxemic shock

Background: Impaired renal microcirculation has been suggested as a factor contributing to the development of renal dysfunction in sepsis. This study was conducted to elucidate the role of endothelin‐1 (ET‐1)in mediating reductions in renal microcirculatory blood flow during endotoxemic shock. Methods: A prospective, randomized, and experimental study was performed with 16 anesthetized and mechanically ventilated pigs. After 2 h of lipopolysaccaride‐induced endotoxemia, eight animals received a bolus dose of the dual endothelin receptor antagonist tezosentan (1 mg/kg), followed by a continuous infusion of 1 mg/kg/h throughout the experiment. Eight animals served as the control group. Renal microcirculation, total renal blood flow, plasma creatinine levels, cardiac index, and mean arterial pressure were measured. Plasma samples were collected for the measurement of tumor necrosis factor α (TNF‐α), interleukin‐6 (IL‐6), interleukin‐10 (IL‐10), ET‐1, angiotensin II, and aldosterone. Results: Endotoxin infusion resulted in a state of circulatory shock with impairment of renal microcirculation. An increase in the plasma levels of TNF‐α, IL‐6, IL‐10, ET‐1, angiotensin II, and aldosterone was also observed. Tezosentan attenuated the decrease in renal microcirculation and renal blood flow, and attenuated the increase in plasma creatinine. Treatment with tezosentan did not significantly affect the plasma cytokine, angiotensin II, or aldosterone response to endotoxemia. Conclusion: These results indicate that treatment with the dual endothelin receptor tezosentan in endotoxemic shock attenuates the reduction of renal microcirculation and total renal blood flow independently of plasma changes in the renin–angiotensin–aldosterone system or early plasma cytokine response.     

Microcirculation in unphysiological flaps at early stage after operation: an experimental study]

Microcirculation and blood perfusion in unphysiological flaps were observed with rabbit ear microcirculation chamber. The microcirculation of the venous flap in two days after operation was reestablished mainly by diversion of blood flow through the "to and fro" movement of venous blood. Arteriovenous anastomoses were gradually opened, resulting in the microcirculation to restore normal perfusion, venous blood through the anastomoses into arteriole then to capillaries. The microcirculation of arterialized venous flaps was almost the same as that of the venous flaps. In two days after operation, the diversion of blood flow perfused the capillaries under high pressure, so that the flow velocity and rate were much faster and larger than those of the venous flaps. The microcirculation of venouslized arterial flap, nourished by venous blood through the arterial system, was the same as that of the physiological flap. But the capillaries were perfused venous blood flow, and the blood flow velocity and rate were much slower and smaller than those of the physiological flap.     

Experimental study on the reconstruction of vascular links between a pedicle skin flap with preserved subcutaneous vascular network and its implanting bed]

A comparative study of skin flap with a preserved subcutaneous vascular network and conventional skin flap was undertaken in rats with determination of skin temperature, laser Doppler, ink perfusion, microangiography and transparent specimen technics. It was found that all the skin flaps with a preserved subcutaneous vascular network survived after transplantation. Three hours postoperation, the flap microcirculation was poorest (LDF, 28% of the preoperative value). Six hours postoperation, it began to augment, and microvessels containing ink could be seen under microscope at 24 hours, as compared to 3 days postoperation in the controls. On the fifth day, LDF returned to the preoperative level, and the diameter and density of reformed microvessels were similar to the vessels of the adjacent skin. This phenomenon only occurred on the 7th day in the controls. After division of the pedicle on the fifth day, all the flaps survived, while the controls showed partial necrosis. The results indicate that skin flaps with a preserved subcutaneous vascular network can survive on the blood flow of pedicle in the early stage, at 24 hours postoperation flap microvessels begin to reform, and on the fifth day flaps can survive on the reformed microcirculation in spite of the severance of the pedicle.