三种灌注液对断指再植组织再灌注损伤保护作用的研究

目的 研究三种不同灌注液对断肢再植后缺血再灌注损伤的保护作用。方法 建立大鼠后肢的断肢再植模型，应用3种不同灌注液（A组肝素钠组，B组肝素钠＋利多卡因组，C组肝素钠＋地塞米松组）对离断肢体进行灌注，然后进行再植。分别于缺血前、缺血6h、通血60min取材，测定断肢皮肤中丙二醛（MDA）、透射电镜观察缺血6h后再通血60min血管内膜的改变。结果 3组再植肢体成活率相当，B组灌注前后MDA差值明显低于A组，差异有统计学意义。B组、C组血管内膜改变较A组轻微。结论 断肢再植前应用含利多卡因、地塞米松灌注液对离断指进行灌注，可以减轻再植肢体的缺血再灌注损伤，且对血管内膜有保护作用。     

利多卡因灌注对再植肢体血循危象后成活的影响

利多卡因局部灌注具有保护微小血管内皮细胞及血管平滑肌的超微结构；促进吻合口内皮细胞的愈合及扩张微小血管，防止血管痉挛的作用[１，２］。目前临床上已将利多卡因局部灌注作为显微外科游离组织移植与再植术中常用的解痉药物，并得到良好疗效。然而，对于再植或移植肢体出现血循危象后，再探查时局部运用利多卡因灌注能否有效地改善再植或移植肢体的血循环，解除微循环内的血管痉挛，挽救血循危象后的肢体尚未见报道。近年，我院对１例前臂离断再植，术后出现血循危象后局部运用利多卡因灌注，有效地改善了微循环，使再植肢体得以成活…     

利多卡因灌注对再植肢体血循危象后成活的影响

利多卡因灌注对再植肢体血循危象后成活的影响刘敏，李世波，贾晋祥，马林，李永鑫，田少斌利多卡因局部灌注具有保护微小血管内皮细胞及血管平滑肌的超微结构；促进吻合口内皮细胞的愈合及扩张微小血管，防止血管痉挛的作用Ｌ’、’Ｊ。目前临床上已将利多卡因局部灌注作...     

大鼠肝移植重建肝动脉对胆管超微结构和并发症的影响

目的 观察大鼠原位肝移植重建肝动脉对肝内胆管上皮细胞缺血再灌注损伤后超微结构及术后胆道并发症的影响.方法 228只SD大鼠分为假手术组(8只)、肝移植重建肝动脉组(55对)和未重建肝动脉组(55对).重建肝动脉组和未重建肝动脉组分别于肝脏复流后0.5、3、6、12、24、36、48 h取材,用透射电镜观察肝内胆管上皮细胞的超微结构,通过计算机图像分析系统对线粒体形态计量分析;观察术后胆道并发症.结果 两组肝内胆管上皮细胞损伤均有加重,表现为线粒体肿胀、嵴模糊或消失、微绒毛减少等超微结构改变,至24 h达高峰,以后逐渐恢复.术后两组线粒体平均面积和周径随时间的延长逐渐增大,线粒体数密度随时问延长而减少.在24 h,两组缺血再灌注损伤最显著,之后均开始缓解.在24、36、48 h,两组线粒体平均面积、平均周径比较,差异均有统计学意义(t=-3.566,-7.780,-4.730,-4.610,-2.599,-5.370,P＜0.05);在36、48 h,两组线粒体平均数密度比较,差异有统计学意义(t=-4.619,4.000,P＜0.05).重建肝动脉组的胆道并发症发生率低于未重建肝动脉组(x2=4.286,P＜0.05).结论 大鼠肝移植重建肝动脉对肝内胆管上皮细胞缺血再灌注损伤后的超微结构具有保护作用,有利于术后恢复和减少胆道并发症的发生.     

不同时段缺血对大鼠骨及血管超微结构的影响

目的 探讨不同时段缺血对SD大鼠骨及血管超微结构的影响。方法 研究材料为SD大鼠骨及血管，进行冷藏缺血和常温缺血实验，缺血时间为1、2、3、4、5、6和8h。以15％DMSO为低温保护剂，采用两步冷冻步骤，标本冷冻预处理温度：骨及动脉为-55℃，静脉为-60℃。液氮保存1周，复温后进行透射电镜观察。结果 缺血8h，冷藏组血管内皮细胞轻度肿胀，胞浆线粒体嵴稀疏或破坏。骨组织与对照组无明显差别；常温组血管内皮细胞坏死增多，残留胞膜。骨细胞核呈固缩表现。结论 冷藏能明显延长骨及血管组织的缺血耐受时间，可获得最大部分生物活性的组织。     

巨脾大部切除后残脾红髓笔毛微动脉超微结构的变化

目的 :观察门静脉高压巨脾大部切除后残脾红髓笔毛微动脉(PA)超微结构的变化,探讨高血流动力对脾小血管内皮细胞超微结构的影响。方法:选取门静脉高压脾肿大患者13例,术后切取脾组织为巨脾组,术后8年穿刺获取脾组织为残脾组,另设外伤性脾组织13例为正常组。采用透射电镜观察脾脏红髓PA内皮细胞的超微结构改变。结果:巨脾组PA内皮细胞细胞核结构完整,染色质分布正常,一部分线粒体肿胀,变大变圆,基质变浅,线粒体嵴变短变少,甚至消失;一部分线粒体扁平嵴变成烧瓶状,甚至空泡状,基质致密,出现髓样变。残脾组PA内皮细胞核结构完整,染色质分布正常,线粒体基质均匀,嵴断裂减少,未见空泡样变和髓样变。正常组PA内皮细胞细胞核结构完整,染色质分布正常,线粒体嵴片状排列,外膜连续,基质均匀,连续内膜中可见包裹。结论:巨脾大部切除术可减少残脾血管PA增生,逆转PA内皮细胞线粒体的变化。     

冷藏对断指血管内皮的保护作用

目的：研究断指常温及冷藏于０℃－４℃时血管内皮细胞超微结构的变化，阐明冷藏对血管内皮细胞的保护作用，提出断指延迟再植的参考时限。方法：将断指体分组冷藏后定时取指动脉标本电镜观察血管内皮细胞超微结构变化。结果：室温组１４小时后血管内皮细胞出现线粒体有空泡、核染色质凝集、核固缩等细胞坏死的早期变化；单纯冷藏组可放置５０小时，用细胞内液泡浸后冷藏放置到６４小时，才出现此坏死改变；加入能量合剂及氧自由基消除剂不能延长保存时限。结论：室温２５℃断指保存至１４小时，单纯冷藏保存至５０小时，用细胞内液泡浸后再冷藏至６４小时时，血管内皮细胞均出现细胞坏死的早期变化，此时限可作为临床延迟再植断指的参考保存时限。     

肝动脉复流时机对大鼠肝内胆管上皮细胞缺血再灌注后超微结构的影响

目的 观察不同肝动脉复流时机对大鼠肝内胆管上皮细胞缺血再灌注损伤后超微结构的影响。方法 建立大鼠原位部分肝脏缺血再灌注损伤模型，54只大鼠随机分为假手术组（SO）、肝动脉先复流组（IAR）和门静脉先复流组（IPR），IAR组、IPR组分别于复流后0．5、2．0、4．0、12．0h时取材，用透射电镜观察肝内胆管上皮细胞的超微结构，通过计算机图像分析系统对线粒体形态计量分析。结果 （1）随着缺血再灌注后时间的延长，IAR组与IPR组肝内胆管上皮细胞损伤均有加重趋势，表现为线粒体肿胀、嵴模糊或消失、微绒毛减少等超微结构改变。（2）IPR 0．5h组、IPR 2h组胆管上皮细胞与IAR组相应时间点比较，超微结构损害无明显加重，线粒体平均面积、平均周径及数密度差异均无统计学意义（P〉0．05）；但IPR 4h组、IPR 12h组与IAR组相应时间点比较，超微结构损害加重，线粒体平均面积增大，差异有统计学意义（P〈0．05），线粒体平均周径增大，差异有统计学意义（P〈0．05），其中IPR 12h组线粒体数密度减少，差异有统计学意义（P〈0．05）。结论 与门静脉先复流相比较，肝动脉先复流对大鼠肝内胆管上皮细胞缺血再灌注后的超微结构具有保护作用。     

肝移植术中应用S-腺苷-L-蛋氨酸对供肝热缺血损伤的影响

目的探讨术中S-腺苷-L-蛋氨酸（SAMe）加入UW液和血浆冲洗液对热缺血损伤供肝及其恢复的影响。方法建立10min热缺血大鼠肝移植模型，分为A组：UW液灌注＋乳酸钠林格氏液冲洗、B组：UW液灌注＋血浆冲洗、C组：SAMe加入UW液灌注＋血浆冲洗和D组：UW液灌注＋SAMe加入血浆冲洗4组，观察肝组织组织病理学变化和电子显微镜下超微结构变化，并检测血清AST和透明质酸。结果C组和D组术后24h血清AST均低于B组（P〈0．05）。A组术后3h和24h血清HA高于B组（P〈0．05），B组复流后3h及24h血清HA均高于C组和D组（P〈0．05）。组织病理学表现B组复流后3h和24h肝细胞损伤和微循环紊乱较C组和D组明显；超微结构表现，A组复流后3h线粒体肿胀，肝窦内皮细胞肿胀，细胞核不规则，可见内皮细胞凋亡，大部分区域肝窦状隙明显狭窄，内皮层结构模糊，红细胞淤积，受压变形，白细胞附壁，可见内皮层完整性破坏；复流后24h，可见线粒体嵴断裂，核融解。B组内皮细胞损伤较A组轻，C组和D组超微结构表现微循环紊乱和肝细胞损伤表现较B组轻。结论供肝切取术中UW液中加入SAMe灌注保存，血浆冲洗液中加入SAMe可改善热缺血供肝微循环，减轻缺血再灌注损伤，并减轻肝细胞热缺血损伤，有利于10min热缺血供肝功能的恢复。     

被冰水浸泡后的断指再植成败的原因分析

目的 探讨被冰水浸泡后的断指再植成败的原因.方法 对9例被冰水浸泡过的断指进行再植,其中5例浸泡时间在6h以内,4例浸泡时间大于6h.在常规断指再植方法下完成再植术,并通过大体及电子显微镜观察术中血管复温后的变化情况,记录两者中血管发生栓塞的情况以及血管内皮细胞等变化,通过比较、分析得出结论.结果 被冰水浸泡过的断指,如果在浸泡6h以内进行再植及复温,虽然再植指体有血运的变化,但再植指全部成活,如果浸泡超过6h,就全部无法再进行再植.结论 被冰水浸泡的断指未超过6h,血管内皮细胞损伤较轻,可以再植成功.而被冰水浸泡超过6h后血管内皮细胞出现严重损伤甚至坏死,在复温的初期还能通血,但随着缺血再灌注损伤的逐渐加重,血管明显扩张,出现血栓且无法再通,最终血管堵塞,无法再植.     

Intact endothelial and contractile function of coronary artery after 8 hours of heart preservation

Abstract

Objectives. The aim of the study was to investigate if adequate preservation of coronary artery endothelium-dependent relaxation and contractility may be obtained after 8?hours of non-ischemic heart preservation. Design. Porcine hearts were perfused for 8?hours at 8?°C, either in cycles of 15?minutes perfusion and 60?minutes non-perfusion, or by continuous perfusion. The perfusate consisted of a cardioplegic, hyperoncotic nutrition solution with oxygenated red cells, and the perfusion pressure was 20?mmHg. In organ baths, coronary artery segments from the preserved hearts were studied and compared to fresh controls. Results. Endothelium-dependent relaxation and contractility were fully preserved after both intermittent and continuous perfusion, as compared to fresh controls. No myocardial edema was seen; water content of the myocardium was 79.5?±?0.2%, 79.0?±?0.4% and 79.0?±?0.3% (ns) for fresh controls, intermittently perfused, and continuously perfused hearts, respectively. Conclusion. Intact endothelial and contractile function of coronary artery may be obtained after 8?hours of non-ischemic heart preservation.     

原位肾低温灌注动物模型的制作

目的 观察原位肾低温灌注动物模型的制作以及低温灌注对术中肾细胞的保护作用.方法 自制肾动脉阻断灌注装置,建立猪肾在体循环低温灌注模型,随机分为3组:假手术对照组、低温灌注组和动脉阻断组(n=8).常规病理学检查、免疫组织化学及透射电镜观察肾组织、细胞形态及超微结构变化.结果 阻断后0.5 h,动脉阻断组肾出现细胞核及线粒体肿胀,胞质水变性.与假手术对照组和低温灌注组比较,细胞凋亡指数(AI)(1.3±0.4)%及Caspase-3蛋白(IOD:2.42±0.62)明显增高(P＜0.05);低温灌注组肾组织仅出现细胞质水变性,细胞核及线粒体未发生明显变化.阻断1 h后,动脉阻断组肾在光镜下可见部分细胞凋亡、坏死,电镜下可见细胞核固缩、核膜轻度溶解,线粒体高度肿胀;而低温灌注组光镜下未见细胞坏死,仅见细胞核及线粒体肿胀、空泡变性.结论 该模型简单易行,低温灌注能有效保护肾组织.     

龙津降纤酶对小血管吻合口内皮细胞愈合的影响

目的 研究龙津降纤酶对小血管吻合口内皮细胞愈合的影响。方法 采用ＳＤ大鼠颈总动脉切断后作端端吻合的模型。根据用药的不同分为龙津降纤酶组、肝素钠组和对照组３组,每组１０只大鼠。根据取材时间,３组各分为术后１５ｍｉｎ、３０ｍｉｎ、１ｈ、２４ｈ和７ｄ共５组。样本用扫描电镜观察血管吻合口内皮细胞的修复过程。结果 龙津降纤酶组血管吻合口的针孔与缝线表面无明显血小板的堆聚,内皮细胞生长时间明显早于对照组,但与     

经肝动脉区域肝脏隔离灌注的研究

目的　研究幼猪经肝动脉区域隔离肝灌注的效果。　方法　14只幼猪随机分为2组:对照组(7只):采用经肝动脉灌注;实验组( 7只):左肝动脉及左肝静脉插管,进行左肝区域隔离肝灌注。灌注液为氨甲喋呤溶液(1mg/kg), 灌注时间为60min。于灌注5、10、20、30、45、60min时分别抽取外周血、肝脏灌注区域血、肝脏未灌注区域血(实验组)测定血药浓度; 灌注后切取左肝及右肝组织进行病理检查。　结果　在所有时间点, 实验组肝脏灌注区域氨甲蝶呤的血药浓度明显高于非灌注区和外周血(P<0. 01), 60min时最高, 达( 40. 211±3. 756 )μg/ml, 而非灌注区和外周血中仅为(1. 584±0. 347)μg/ml和(0. 773±0. 096)μg/ml。实验组灌注区域血药浓度均高于对照组肝脏血药浓度(P<0. 01), 60min时分别达(40. 211±3. 756)μg/ml和(4. 498±1. 643)μg/ml。实验组灌注区浓度-时间曲线下面积为218. 295μg/ml,而在对照组肝脏仅为260. 860μg/ml。病理检查提示两组灌注肝脏均有肝细胞浊肿、气球样细胞,但实验组肝脏灌注区域肝细胞坏死率为85. 7% (6 /7),明显高于对照组28. 6% (2 /7)。实验组肝脏未灌注区域无明显病理损害。　结论　动物实验证实经肝动脉区域隔离肝灌注是一种灌注及隔离效果好、肝功能损害小的区域化疗方法。     

Cyanotic painful index and long fingers associated with an asymptomatic ulnar artery aneurysm: Case report

A single patient is reviewed in whom painful and cyanotic index and long fingers of the right hand were seen in association with an otherwise asymptomatic u1nar artery aneurysm. The patient was evaluated by digital plethysmography and preoperative arteriography with findings at surgery consistent with peripheral emboli having been thrown from his ulnar artery aneurysm. Following resection of the aneurysm and repair of his ulnar artery, digital perfusion has continued to improve and a digital subtraction angiogram has shown patency of his ulnur artery repair.     

改良邻指指动脉逆行岛状皮瓣的应用

目的 探讨改良邻指指动脉逆行岛状皮瓣修复手指中节以远掌侧皮肤软组织缺损的手术方法。方法 以指总动脉作为邻、患指指掌侧固有动脉逆行供血通道，在患指近侧指间关节近侧平面为旋转点，设计邻指指动脉岛状皮瓣逆行翻转，修复10例手指中节以远掌侧皮肤软组织缺损，同时将皮瓣上的感觉神经与患指远端指神经缝合。结果 10例皮瓣全部成活，术后随访6～15个月。手指外观饱满，皮瓣颜色与正常手指相似，皮瓣质软，两点分辨觉为4mm。供区手指功能无影响。结论 改良邻指指动脉逆行岛状皮瓣适用于修复手指中节以远掌侧皮肤软组织缺损创面的覆盖，术后疗效满意。     

Successful replantation of circularly severed palm and multiply severed fingers. A case report]

Replantation of a circularly severed palm, partially severed middle finger and completely severed ring and small fingers was done successfully in one patient. Two palmar arteries, 5 digital arteries, 3 dorsal palmar veins, 9 dorsal digital veins were anastomosed. Vein transplantation was carried out to repair the ulnar digital artery defect of the middle finger. Severe swelling after arterial thrombosis was noted on the 7th day and was eliminated by the use of urokinase. All the replanted parts survived with good functional results. Precise anastomosis, prevention and treatment of thrombosis, early exercises were essential to the survival of fingers and functional recovery of hand.     

Protective effect of prostaglandin E1 against ischemia of spinal cord during aortic cross clamping

PURPOSE: The purpose of this study was to investigate whether or not 5-minute segmental intraaortic perfusion of prostaglandin E1 (PGE1) in the preischemic period has a protective effect against spinal cord ischemia during aortic cross clamping. METHODS: The rabbits were divided into two groups. In group A (n = 6), the infrarenal aorta was segmentally cross clamped and the segment was perfused for 5 minutes with blood and saline solution at first. The aorta was kept cross clamped without perfusion for a subsequent 20 minutes. In group B (n = 6), the infrarenal aorta was segmentally cross clamped and the segment was perfused for 5 minutes with blood and saline solution containing PGE1 of 100 ng/kg/min at first. The aorta was kept cross clamped without perfusion for a subsequent 20 minutes. After the aorta was declamped, the experimental animals recovered from the anesthesia. Twenty-four and 48 hours after the operation, the hind limb function was estimated with Tarlov's grade. Then, the animals were killed for pathologic study. RESULTS: The systolic arterial pressures measured at the left common carotid artery through the experiment were not significantly different between the two groups. The perfusion of the aortic segment between the proximal and distal clamp was nonpulsatile. The perfusion pressures of the aortic segments at 5 minutes after aortic cross clamping were 29 +/- 6 mm Hg and 33 +/- 6 mm Hg in groups A and B, respectively. No significant differences were seen between the two groups. In group A, the hind limb functions evaluated with Tarlov's grade after 24 hours and 48 hours were 0 to 3 (1.5 +/- 1.4) and 0 to 3 (1.3 +/- 1.4), respectively. In group B, these were 3 to 4 (3.5 +/- 0.5) and 3 to 4 (3.7 +/- 0.5), respectively. A significant difference was seen between the two groups (P <.05). In the ventral horn of the L5, L6, and L7 segments, large motor neurons that seemed viable were more preserved in group B than in group A. CONCLUSION: Segmental intraaortic perfusion of PGE1 in the preischemic period reduced neurologic damage of spinal cord ischemia.     

Scanning electron microscopic observations of common carotid artery endothelium in the rat. I. Crater artifacts.

Changes in the endothelial surface of the common carotid artery of the Sprague-Dawley rat were observed by scanning electron microscopy after vessels were removed prior to sacrifice or after gluteraldehyde cardiac perfusion. Rates were classified according to whether the vessels was 1) untouched prior to removal, 2) dissected and observed for a period of time, and 3) clamped and observed. Changes consisted of small 1-6 micron craters as well as smooth or cross-striated endothelial ridges or folds. Clamped arteries appeared to exhibit more frequent craters. In contrast, vessels removed prior to death and briefly washed with saline exhibited craters different morphologically from those vessels perfused with gluteraldehyde. Background endothelial folds also differed from the gluteraldehyde-perfused group, exhibiting a cobblestoned or breaded appearance with distorted endothelial bridges. This supports the suggestion of Nelson that premortem perfusion of heart and ascending aorta with gluteraldehyde is necessary to reduce artifact in arterial endothelial structures.     

小口径异种血管作为冠状动脉旁路移植术桥材料的研究

目的 研制和评价一种新型小口径异种血管，为冠状动脉旁路移植术（CABG）提供新的移植血管来源。方法 将犬颈动脉采用酶-去污剂法进行脱细胞处理，脱细胞后随机分为两组，肝素结合组（n=24）：进一步进行肝素结合处理；肝素未结合组（n=24）：仅脱细胞作为对照。两组的脱细胞异种血管同时分别植入同一只兔左、右侧颈动脉，在3周、3个月和6个月时用B超观察移植血管的通畅情况；3个月和6个月时分别取材行组织学、电子显微镜及免疫组织化学检查。结果 犬颈动脉细胞被完全去除，肝素结合于血管管壁全层。脱细胞异种血管植入兔颈动脉后两组均无血管阻塞，而肝素结合组血栓形成少于肝素未结合组。移植后3个月两组中无血栓形成的血管管壁均出现大量平滑肌细胞，而内腔由内皮细胞覆盖。结论 酶-去污剂联合肝素处理的犬颈动脉，有可能作为CABG的一种新型小口径异种移植血管。