桃红四物汤联合辛伐他汀对大鼠上肢随意皮瓣存活的影响和机制研究

目的:考察桃红四物汤联合辛伐他汀对大鼠上肢随意皮瓣存活的影响和机制。方法:24只大鼠,体重180²20 g,被随机分为模型对照组、桃红四物汤组、辛伐他汀组和联用组(桃红四物汤+辛伐他汀),采用1%异戊巴比妥钠腹腔内注射(7 mg/m L)麻醉,硫化钠脱毛,温水洗净后,与大鼠背部脊柱两侧设计8cm×2cm随意皮瓣,模型对照组给予生理盐水治疗,桃红四物汤组和辛伐他汀组分别采用桃红四物汤和辛伐他汀单独治疗,联用组采用桃红四物汤+辛伐他汀治疗,给予药物治疗10 d后,观察各组随意皮瓣外观、MVD、存活率,检测组织中丙二醛(MDA)、超氧化物歧化酶(SOD)、间黏附分子-1(ICAM-1)和一氧化氮合成酶(NOS)的表达水平。结果:联用组坏死面积最少,原味掀起皮瓣出血最多,可见血管数最多;联用组皮瓣存活率最高,与辛伐他汀组、桃红四物汤组比均有统计学差异(72.24±9.25 vs 57.88±10.76,P<0.05;72.24±9.25 vs 57.88±10.76,P<0.05);各组在皮瓣近段MVD均无统计学差异(P>0.05),皮瓣中段MVD模型组和辛伐他汀组、桃红四物汤组MVD显著低于联用组(8.23±1.23vs17.24±1.25,P<0.01;13.55±1.16vs17.24±1.25,P<0.01;14.88±1.76vs17.24±1.25,P<0.05);在MDA指标中,联用组相对于辛伐他汀组、模型对照组具有统计学差异(4.47±0.59 vs5.43±0.76,P<0.05;4.47±0.59 vs 6.21±0.81,P<0.01);在SOD指标中,联用组相对于模型对照组、辛伐他汀组、桃红四物汤组具有统计学差异(312.62±23.99 vs 174.61±23.91,P<0.01;312.62±23.99 vs 222.24±27.12,P<0.01;312.62±23.99 vs 275.22±24.78,P<0.05);NOS指标中,联用组相较于模型对照组、桃红四物汤组均有显著性统计学差异(9.32±0.24 vs 7.24±0.68,P<0.01;9.32±0.24 vs 7.52±0.52,P<0.01);ICAM-1指标中,联用组相较于桃红四物汤组、模型对照组具有统计学差异(2.97±0.49 vs 3.78±0.62,P<0.05;2.97±0.49 vs4.15±0.41,P<0.01)。结论:桃红四物汤联合辛伐他汀可通过增加组织对缺血的耐受能力、减轻炎症反应增加皮瓣的存活率。

Experimental Study of Effect and Mechanism of Simvastatin Combined with Taohong Siwu Decoction on Survival of Random Flaps in Rats

Objective： To investigate the effect and mechanism of simvastatin combined with Taohong Siwu Decoction on the survival of random skin flaps in rats. Methods： 24 rats,weighing 180 ~ 220 g,were randomly divided into the model group,Taohong Siwu Decoction group,simvastatin group and the combination group（ Taohong Siwu Decoction ＋ simvastatin）. All animals were created random flap model. Using 1% amobarbital sodium（ 7 mg / mL） by the intraperitoneal injection for anesthesia and sodium sulfide for depilation and after washing with warm water,the 8cm × 2cm random skin flap model was made by designing at the back of the spine on both sides. The control group received saline treatment and Taohong Siwu Decoction group and the simvastatin group were used Taohong Siwu Decoction and simvastatin respectively and the combination group received Taohong Siwu Decoction ＋ simvastatin treatment. After treatment for 10 d,the appearance of random flap and the survival rate were observed. Malondialdehyde（ MDA）,superoxide dismutase（ SOD）,MVD,inter-cellular adhesion molecule- 1（ ICAM- 1） and nitric oxide synthase（ NOS） in each groups were detected. Results： The combination group had the least necrotic area,the most original flap bleeding and the maximum number of visible blood vessels. The combination group had the highest flap survival rate and compared with that of the simvastatin group and Taohong Siwu Decoction group,there was statistical difference（ 72. 24 ± 9. 25 vs 57. 88 ± 10. 76,P〈0. 05; 72. 24 ±9. 25 vs 57. 88 ± 10. 76,P〈0. 05）. In the each group,there were no statistical difference in proximal MVD（ P〈0. 05）. As for the middle flap MVD,the model group and simvastatin group and Taohong Siwu Decoction group were significantly lower than those of the combination group（ 8. 23 ± 1. 23 vs 17. 24 ± 1. 25,P〈0. 01; 13. 55 ± 1. 16 vs 17. 24 ±1. 25,P〈0. 01; 72. 24 ± 9. 25 vs 57. 88 ± 10. 76,P〈0. 05）. For MDA indicators,the combination group had significant difference co