局部应用水蛭素对扩张皮瓣静脉淤血的防治

目的探讨局部应用水蛭素对扩张皮瓣静脉淤血的防治作用.方法以白色小型家猪为实验对象,将其模拟成扩张皮肤转移术后的淤血皮瓣,随机分成三组,A组(局部注射天然水蛭素,0.5 U/皮瓣)、B组(局部注射天然水蛭素,1 U/皮瓣)和对照组.进行大体观察、病理切片和ET-1、NO、TXB2的测定.结果用药组(A组与B组间差异无显著意义)术后与对照组比较淤血消散快.光镜下用药组与对照组微血管淤血同期比较有明显差异.用药组的ET-1、NO、TXB2与对照组同期比较差异有显著意义(P＜0.05).结论水蛭素的局部应用对扩张皮瓣静脉淤血有明显的防治作用.     

天然及重组水蛭素对大鼠随意皮瓣中ET和TXB2的影响

目的 通过检测大鼠随意皮瓣中ET和TXB2的含量,探讨局部应用天然及重组的水蛭素对随意皮瓣静脉淤血的影响.方法 自2009年4月至2009年8月,选取健康的Wistrar大鼠21只,随机分为A、B、C 3个组,于所有大鼠的背部设计并制作超长随意皮瓣淤血模型后,A组局部注射天然水蛭素;B组局部注射重组水蛭素;对照C组局部注射生理盐水.于皮瓣远端切取组织块,检测内皮素(ET)、血栓素B2(TXB2)的含量.计算各组皮瓣的成活率,取成活皮瓣组织行常规HE染色后计数炎性细胞和微血管的数量.结果 各组中ET-1的含量:注射后第5天和第7天,C组中ET-1的含量高于A、B两组,其差异有统计学意义(P<0.05).各组中TXB2的含量:注射后第3天和第5天,C组中TKB2的含量高于A、B两组,其差异有统计学意义(P<0.05).A组中TXB2的含量高于B组,但两组比较其差异无统计学意义(P>0.05).结论 局部应用天然及重组的水蛭素使移植后的大鼠随意皮瓣中ET、TXB2的含量降低.由此推断,天然及重组的水蛭素对移植后随意皮瓣的静脉淤血可有改善作用.     

天然水蛭素对猪随意型皮瓣静脉淤血影响的实验研究

目的 探讨局部应用天然水蛭素对猪随意型皮瓣移植后静脉淤血的影响. 方法 6～8月龄广西巴马小型猪3只,雌雄不限,体重10～15 kg.于每只猪背两侧制备6个大小为14 cm×4 cm的随意型皮瓣,共18个皮瓣.根据术后注射药物不同,皮瓣随机分为3组(n=6).术后即刻、1、2、3 d,A组:局部注射3 mL生理盐水,作为对照组;B组:局部注射3 mL天然水蛭素20 ATU:C组:局部注射3 mL天然水蛭素40 ATU.术后1、10 d行大体观察,1、7d行组织学观察,3、7 d测定湿重/干重比值,5 d测定皮瓣表面温度,7 d皮瓣局部血流彩色超声检测,12 d测定皮瓣成活率. 结果 术后即刻,3组皮瓣均出现远端2/3范围内轻度淤血,差异无统计学意义(P＞O.05):术后1 d,A组皮瓣淤血长度明显长于B、C组(P＜0.05),B、C组间比较差异无统计学意义(P＞0.05);术后10 d,A、C组皮瓣坏死长度明显长于B组,差异有统计学意义(P＜0.05),A、C组比较差异无统计学意义(P＞0.05).组织学观察:术后1 d,B组真皮内毛细血管及微静脉红细胞淤滞现象较A组明显减轻;术后7 d,B组皮下胶原及肉芽组织增生明显优于A组.术后3 d,A、B、C组湿重/干重比值分别为3.94 4±0.14、3.43±0.14、3.60±0.19,A组与B、C组比较,差异有统计学意义(P＜0.05),B、C组间比较,差异无统计学意义(P＞0.05);术后7 d,A、B、C组湿重/干重比值分别为3.61±0.11、3.08±0.13、3.34±0.21,A组与B、C组比较,差异有统计学意义(P＜0.05),B、C组间比较,差异无统计学意义(P＞0.05).术后5 d,A、B、C组皮瓣表面温度分别为(36.64±0.70)、(38.61±0.42)和(37.50±0.46)℃,A组与B、C组比较差异有统计学意义(P＜0.05),B、C组间比较,差异无统计学意义(P＞0.05).术后7 d,皮瓣局部血流彩色超声检测示A组血流信号稀少,B组见较完整的动静脉回流信号,可见垂直于皮肤的动脉穿支,C组可见动脉血流信号.术后12 d,A、B、C组皮瓣成活率分别为45%4±7%、67%±4%、52%±4%,B、C组与A组比较,筹异有统计学意义(P＜0.05),B、C组问比较差异有统计学意义(P＜0.05). 结论 局部应用天然水蛭素对猪随意犁皮瓣移植后静脉淤血有较明显的改善作用.     

重组水蛭素对大鼠撕脱皮瓣存活的影响

目的 探讨重组水蛭素对撕脱皮瓣的保护作用及其在临床治疗撕脱皮瓣的应用前景.方法 将108只SD大鼠随机分为重组水蛭素组（A组）、低分子肝素组（B组）、生理盐水组（C组,对照组）,并形成撕脱皮瓣后原位缝合.术后即刻、12 h、24 h、48 h,给予皮瓣蒂部、距蒂部2 cm和4 cm3等分点皮下注射重组水蛭素、低分子肝素、生理盐水,于术后12 h、1d、3d、5d、7d,分别检测皮瓣远端组织内P选择素和血管内皮细胞生长因子（VEGF）含量,病理切片观察皮瓣远端组织毛细血管内炎性细胞聚集及微血栓形成情况,术后14d计算皮瓣存活率.结果 A组P选择素含量比B组、C组增加不明显,差异具有统计学意义（P＜0.05）,A组VEGF含量比B组、C组明显增加,差异具有统计学意义（P＜0.05）;术后14 d皮瓣存活率A组明显高于B组（P＜0.05）和C组（P＜0.01）,差异具有统计学意义.结论 局部注射重组水蛭素能有效抑制P选择素的生成,减少炎性细胞的聚集,阻断微血栓的形成,改善撕脱皮瓣的局部缺血、缺氧状态;减弱内皮细胞的损伤,促进VEGF的表达,刺激新生毛细血管增生,提高撕脱皮瓣的存活率.     

天然水蛭素联合高压氧治疗对大鼠随意皮瓣成活的影响研究

目的探讨天然水蛭素联合高压氧治疗对大鼠随意皮瓣成活的影响。方法取72只SD大鼠,于背部制备面积为10.0 cm×2.5 cm的随意皮瓣移植模型后,随机分为4组(n=18)。对照组术后即刻及之后4 d内注射生理盐水,高压氧组注射生理盐水同时行高压氧治疗,水蛭素组仅注射天然水蛭素,联合组注射天然水蛭素同时行高压氧治疗。术后大体观察皮瓣成活情况,第6天计算皮瓣成活率;第2、4天取材,HE染色观察皮瓣组织学变化;免疫组织化学染色检测皮瓣微血管密度(microvessel density,MVD)以及TNF-α表达水平。结果术后各组皮瓣均出现部分坏死,其中联合组皮瓣成活最佳;术后第6天高压氧组、水蛭素组及联合组皮瓣成活率明显高于对照组,联合组高于水蛭素组、高压氧组,比较差异有统计学意义(P0.05);水蛭素组与高压氧组比较,差异无统计学意义(P0.05)。组织学观察示,术后第2天,水蛭素组、高压氧组及联合组微血管结构较对照组多,各组均见炎性细胞浸润;第4天,高压氧组、水蛭素组及联合组中仍可见较多微血管形成,对照组中见大量炎性细胞浸润,其余各组炎性细胞均较术后第2天时明显减少。免疫组织化学染色观察示,术后第2天,高压氧组、水蛭素组及联合组MVD均显著高于对照组、TNF-α蛋白表达量显著低于对照组(P0.05);高压氧组、水蛭素组及联合组以上指标比较,差异无统计学意义(P0.05)。术后第4天,高压氧组、水蛭素组及联合组MVD均显著高于对照组,联合组及水蛭素组高于高压氧组,比较差异有统计学意义(P0.05),联合组及水蛭素组间比较差异无统计学意义(P0.05);高压氧组、水蛭素组及联合组TNF-α蛋白表达量显著低于对照组,联合组低于水蛭素组及高压氧组,比较差异有统计学意义(P0.05),水蛭素组及高压氧组间比较差异无统计学意义(P0.05)。结论高压氧和天然水蛭素干预均能提高随意皮瓣移植后成活率,且两者联合发挥协同效应,可能与促进血管生成和减轻炎性反应有关。     

天然水蛭素对大鼠缺血皮瓣血管生成作用的Micro-CT观察

目的通过Micro-CT及三维重建技术观察天然水蛭素对大鼠缺血皮瓣血管生成的影响。方法选取32只成年SD大鼠,在其背部制备一8.0cm×1.8cm大小的缺血皮瓣模型,然后随机分为水蛭素组和对照组(n=16)。水蛭素组术后即刻和术后3 d内每天皮下注射天然水蛭素0.3 mL(含天然水蛭素6 ATU),对照组皮下注射等量生理盐水。术后6 d,大体观察皮瓣成活情况并测定皮瓣成活率,取材行HE染色观察皮瓣组织学变化,行Micro-CT三维重建观察并测量皮瓣血管容积、长度及数量。结果术后两组大鼠均存活至实验完成,无感染发生。术后6 d,两组皮瓣远端均发生不同程度坏死,水蛭素组皮瓣成活率为72.11%±8.97%,显著高于对照组的58.94%±4.02%,差异有统计学意义(t=3.280,P=0.008)。组织学观察示水蛭素组较对照组组织结构层次更清楚,有较多微血管生成,炎症反应及炎症细胞浸润更轻。Micro-CT三维重建示水蛭素组皮瓣血管更多、更加密集;血管容积、长度及数量均显著大于对照组(P<0.05)。结论天然水蛭素可减轻组织炎症反应、促进缺血皮瓣血管的新生与再通,从而提高皮瓣成活率。     

局部应用重组水蛭素对家兔耳静脉淤血皮瓣成活的影响

目的 观察局部应用重组水蛭素对家兔耳静脉淤血皮瓣成活的影响.方法 选取健康普通大耳白兔18只,按照随机数字表法分为对照组、低分子肝素治疗组、重组水蛭素治疗组,每组6只.各组家兔麻醉后在左耳背制作静脉淤血皮瓣模型:皮瓣大小为6 cm×3 cm,以耳中心动脉为惟一血供、1 cm宽蒂部为惟一静脉回流途径.术后分别于皮瓣下多点均匀注射 1 mL生理盐水、低分子肝素(625 U)、重组水蛭素(1 U),皮瓣原位缝合.观察皮瓣外观并计算成活率;术后1、3、5、7 d 取皮瓣远端组织检测血栓素B2含量.对数据行单因素方差分析、t检验.结果 各组家兔皮瓣完全坏死区域毛发脱落明显;术后皮瓣均肿胀明显,远端淤血形成,对照组颜色明显深于2个治疗组.术后1 d 重组水蛭素治疗组1只家兔、低分子肝素治疗组2只家兔、对照组4只家兔出现明显血肿.低分子肝素治疗组、重组水蛭素治疗组家兔皮瓣成活率分别为(92.3±1.7)%、(94.8±1.9)%,均高于对照组[(77.9±1.2)%,F=191.29,P＜0.05].2个治疗组家兔皮瓣成活率接近(t=2.75,P>0.05).术后3、5 d,2个治疗组家兔血栓素B2含量均明显低于对照组(t值为6.68~30.55,P值均小于0.01),而2个治疗组家兔血栓素B2含量接近(t值分别为1.22、6.44,P值均大于0.05).结论 局部应用低分子肝素或重组水蛭素,可明显改善家兔皮瓣的静脉淤血,提高皮瓣成活率.

Abstract：

Objective To observe the effect of local injection of recombinant hirudin on survival of skin flaps with venous congestion in a rabbit model. Methods Eighteen healthy rabbits were enrolled and divided into heparin-treatment (HT),recombinant hirudin treatment (RHT) and control (C) groups according to the random number table,with 6 rabbits in each group. After intravenous anesthesia with 20 g/L pentobarbital sodium,model of skin flaps with venous congestion in the size of 6 cm×3 cm was reproduced in the dorsal side of left ear of each rabbit,in which central artery of ear served as the only blood supply,and a pedicle of 1 cm in width including central vessel of ear and its accompanying nerves as the only venous return pathway. Each flap in RHT,HT,C groups was respectively given 1 mL recombinant hirudin (1 U),low-molecular-weight heparin (625 U),and isotonic saline via multi-point and homogenous injection,then they were sutured in site. Appearance and survival rate of the flaps were observed after operation. Specimens of the distal part of flaps were harvested for determination of thromboxane B2 (TXB2) on post operation day (POD) 1,3,5,7. Data were processed with one-way analysis of variance and t test. Results Rabbit model of skin flaps with venous congestion was reproduced successfully. Obvious hair loss was observed in completely necrotic parts of flap in each group. Obvious edema was observed in all flaps with venous congestion at distal site. The color of flaps in HT and RHT groups were lighter as compared with that in C group,and apparent hematoma of flap was observed in 1 rabbit of RHT group,2 rabbits of HT group,4 rabbits of C group on POD 1. The survival rate of flap in HT and RHT groups was respectively (92.3±1.7)% and (94.8±1.9)%,both higher than that in C group[(77.9±1.2)%,F=191.29,P＜0.05]. There was no statistical difference in survival rate of flap between HT group and RHT group (t=2.75,P>0.05). The content of TXB2 in HT and RHT groups on POD 3,5 was respectively lower than that in C group (with t value from 6.68 to 30.55,P values all below 0.01),but there was no statistical difference between HT and RHT groups (with t value respectively 1.22,6.44,P values all above 0.05). Conclusions Local injection of low-molecular-weight heparin or recombinant hirudin can significantly ameliorate venous congestion of skin flap in rabbit ear,and improve its survival rate.     

家兔逆行隐动脉皮瓣中静脉干对静脉回流影响的实验研究

目的通过活体动物实验模型，研究家兔逆行岛状皮瓣中静脉干对皮瓣静脉回流的影响。方法利用家兔隐动静脉模型做成逆行岛状皮瓣的实验模型，实验分为3组：A组静脉干组（皮瓣蒂远端结扎静脉干）；B组无静脉干组（皮瓣近端、远端结扎静脉干）；C组静脉干＋表面渗出组（皮瓣远端结扎静脉），在皮瓣表面作切口引流。观察初始、术后各个时间段静脉干对皮瓣静脉回流的影响。观察指标：皮瓣大体观察；静脉压力测定；血管口径、血流情况观察；组织学检查。结果静脉压测定：A，B，C组皮瓣术后静脉压力均较术前升高（P〈0.05）；A，B组皮瓣的静脉压在术后各时间点的差异有统计学意义（P〈0.05），C组与A组无明显差异。微循环观测：三组皮瓣蒂部静脉干的血管口径在术后均有不同程度扩张，B组管径扩张程度较A，C组明显，A，C组血管管径至术后7d时接近术前水平；但B组仍高于初始水平。A，C组皮瓣蒂部静脉干开始血流方向由皮瓣蒂部向皮瓣远端流动，而后血流速度减慢；自术后2h，皮瓣内血液开始直接通过静脉干向皮瓣蒂部逆流。B组皮瓣蒂部静脉干未见静脉中有血液流动。术后12d观察，B组皮瓣中可见新生小血管，皮瓣成活率最低。结论静脉干对逆行岛状皮瓣的静脉回流起促进作用；静脉瓣膜失效机制在逆行岛状皮瓣静脉回流过程中起主要作用；单纯依靠迷宫式回流不能保证皮瓣静脉充分回流；增加皮瓣表面渗出在皮瓣静脉回流中未见明显作用。     

不同灌流方式下动脉化静脉皮瓣用于手部软组织缺损修复临床对比研究

目的: 探讨静脉逆瓣膜动脉化倒置吻合和静脉顺瓣膜动脉化不倒置吻合灌流方式用于手部软组织缺损修复临床效果差异。方法：研究对象选取我院2014年4月-2016年4月收治行动脉化静脉皮瓣修复手部软组织缺损患者80例,以随机数字表法分为A组（40例）和B组（40）,分别采用静脉逆瓣膜动脉化倒置吻合和静脉顺瓣膜动脉化不倒置吻合灌流;比较两组患者手功能恢复优良率、皮瓣成活率、术后皮瓣反应分度及治疗满意度。结果：两组患者手功能恢复优良率比较差异无统计学意义（p>0.05）;B组患者术后皮瓣成活率显著高于A组（p<0.05）;B组患者术后皮瓣反应分度显著优于A组（p<0.05）;同时两组患者治疗满意度比较差异无统计学意义（p>0.05）。结论：静脉顺瓣膜动脉化不倒置吻合灌流用于手部软组织缺损修复可有效提高皮瓣存活率,改善术后皮瓣反应程度,价值优于静脉逆瓣膜动脉化倒置吻合。     

别嘌呤醇对慢性肾衰竭患者肾脏保护作用及机制

目的观察别嘌呤醇对慢性肾衰竭（CRF）患者肾功能的保护作用。方法将入选的86例CRF（除外尿酸性肾病）患者分成对照组和治疗组,对照组给予CRF常规非透析疗法治疗;治疗组则在对照组基础上加用别嘌呤醇治疗;观察4周。测定2组治疗前后患者的尿素氮（BUN）、血肌酐（SCr）、血尿酸、一氧化氮（NO）,内皮素1（ET-1）,血栓素B2（TXB2）、6-酮-前列腺素F1α（6-keto-PGF-1α）及超敏C反应蛋白（hs-CRP）。结果治疗组治疗后,BUN、SCr及血尿酸较同组治疗前显著降低（P〈0．05）,与对照组比较有统计学差异（P〈0．05）;ET-1和NO分别较同组治疗前降低和升高（P〈0．05）,TXB2和6-keto-PGF-1α分别较治疗前降低和升高（P〈0．05）,hs-CRP较同组治疗前下降（P〈0．05）,与对照组比较均有统计学差异（P〈0．05）。结论别嘌呤醇对CRF患者肾功能具有保护作用,其可能是通过抗微炎症状况和改善血管内皮功能的作用。     

Effects of natural and recombinant hirudin on superoxide dismutase, malondialdehyde and endothelin levels in a random pattern skin flap model

We have assessed the anti-inflammatory, anti-oxidative and anti-coagulant effects of locally applied natural and recombinant hirudin in a random skin flap rat model. Thirty Wistar rats with venous congested skin flaps were randomly divided into two treatment groups and a control group to receive subcutaneous injections of natural hirudin (6 U), recombinant hirudin (6 U) or physiological saline, respectively. Superoxide dismutase, malondialdehyde and endothelin levels as well as flap survival rates of the skin flaps were measured after surgery. Compared to the control group, the treatment groups had significant higher superoxide dismutase levels and lower malondialdehyde and endothelin levels in the skin flaps. The surviving areas of the flaps were larger in the treatment groups than the control group. Our results demonstrated that hirudin could improve skin flap survival through its anti-inflammatory, anti-oxidative and anti-coagulant activities.     

白术多糖预处理对大鼠肝脏缺血再灌注损伤的实验研究

目的:研究白术多糖(AMP)对大鼠肝脏缺血再灌注损伤的影响及作用机制。方法:将72只成年雄性SD大鼠随机分成3组:假手术组(Sham组)、缺血再灌注组(HIRI组)、AMP预处理缺血再灌注组(AMP组)。缺血60 min后分别再灌注1、6、24 h后取材,测定血清谷丙转氨酶(ALT)、谷草转氨酶(AST)及一氧化氮(NO)、内皮素(ET-1)水平,光镜及透射电镜下观察各组肝细胞的显微结构及超微结构变化。结果:AMP组及HIRI组ALT、AST水平均高于Sham组;与HIRI组比较,AMP组ALT、AST水平显著降低(P<0.05)。与Sham组比较,HIRI组及AMP组术后各时段的NO水平均明显降低,ET-1水平明显升高,术后6 h时明显(P<0.05);与HIRI组相比较,AMP组术后各时段NO水平升高,而ET-1水平降低,差异有统计学意义(P<0.05)。光镜下HIRI组大鼠肝细胞肿胀、变性坏死,肝血窦变窄、淤血及炎性细胞浸润等,而AMP组明显好转。电镜下HIRI组大鼠肝细胞线粒体细胞核皱缩变形,染色质粗糙,核仁浓缩甚至裂解,部分膜破裂,线粒体嵴疏松溶解等,而AMP组明显好转。结论:AMP可以提高缺血再灌注大鼠体内NO水平,同时降低ET-1水平,改善肝脏微循环障碍,对肝脏起保护作用。     

The effect of recombinant hirudin on rabbit ear flaps with venous insufficiency

The effect of recombinant hirudin, which is the most powerful antithrombotic agent, on flaps with venous insufficiency was investigated. Oedema and congestion are frequent on flaps, causing necrosis unpredictably. Venous insufficiency and thrombosis are experimentally and clinically more frequent than arterial occlusion. Twenty-one adult New Zealand rabbits were used in this study. Skin flaps (3 × 6 cm) were elevated on a 1-cm-wide pedicle on rabbit ears. The artery, nerve, and vein were exposed and examined with the aid of a surgical microscope. Venous insufficiency was established by cutting the vein and nerve. In the control group, no additional surgical or medical procedures were performed and the ear flap was inset to its original location. Subcutaneous low molecular weight heparin (LMWH; 320 IU/kg) was administered to a second group of rabbits after the same surgery, and recombinant hirudin (2 μg) was administered via the pedicle artery 5 minutes after the vein and nerve were bound and cut in a third group of rabbits. Compared with control and LMWH groups on day 3 and 7, the hirudin-treated group had less hair loss, lower oedema scores and less haematoma formation. Furthermore, a lower size of necrotic areas and an increase in the circulating area on day 7 was found in the hirudin-treated group. In addition, angiography revealed new vessel development (neovascularisation) only in the hirudin group. On histologic sections, hirudin-treated animals had lower oedema, inflammation and congestion scores than animals in the other two groups. Thus, when administered into the ear flap through the pedicle as a pure recombinant preparation, hirudin increased flap survival by its antithrombotic effects and by accelerating neoangiogenesis. Recombinant hirudin may be used in clinical practice to treat flaps with venous problems and to increase survival rates.KEY WORDS: Flap, hirudin, venous insufficiency     

肝素对顿抑心肌功能影响的实验研究

目的：探讨肝素化剂量肝素对在体家兔短暂缺血－再灌注顿抑心肌的功能的影响。方法：23只雄性家兔，分为实验（A）组和对照（B）组，建立在体心肌短暂缺血（15min）－再灌主（60min）损伤模型。A组于前降支阻断前20min给予肝素（700U／kg）。分别于给药前、缺血前、再灌注期间，检测2组NO、ET－1、MDA、SOD水平，测定血流动力学指标变化，对心肌超微结构做定性观察。结果：A组在给药后20min，NO含量即较给药前明显升高（P＜0．05），且在整个再灌注期较B组有显著性差别（P＜0．05），心功能、超微结构明显改善。结论：肝素参与短暂缺血－再灌注顿抑心肌功能的保护，机制可能是通过药物性预适应，增强内皮源性NO的产生，从而减轻心肌缺血－再灌注损伤。     

Improvement of length of survival of expanded flap by application of topical papaverine cream

Abstract

Blood flow in expanding tissue can be improved by papaverine through a special delivery system in early report. Because the delivery system was complex and inconvenient, another way of using papaverine was tested to observe the blood flow and the survival length of expanded flap in this study. Twenty-four pigs were divided into three groups randomly named A, B, and C. Four soft tissue expanders (150 millilitres) were implanted into each pig in group A and C. Another four modificatory rectangular expanders were implanted into each pig in group B. A laser Doppler blood velocimeter was used to measure the blood flow. During the expanding process, 1 gram (containing 2% hydrochloride papaverine) of hydrochloride papaverine cream was applied topically on the surface of each expanding skin in group A twice daily. Two millilitres of hydrochloride papaverine (containing 30 milligrams of hydrochloride papaverine) solution was injected into each outer shell of the modificatory expander in group B weekly. Group C acted as control group. A 15 × 3 centimetre random flap was evaluated from the expanded skin after expanding and the survival length measured. The value of blood flow increased more significantly in group A than groups B and C. There were statistical differences. The survival length of the expanded flap in group A was the longest among the three groups, and there were statistical differences too. This study shows that the survival length of expanded flap can be increased by application of papaverine cream topically during the expanding process.     

Microvascular repair following crush-avulsion type injury with vein grafts: effect of direct inhibitors of thrombin on patency rate

The aim of this study was to develop a standardized effective thrombogenic arterial anastomosis model, as usually encountered in clinical practice, and to offer a detailed evaluation of the antithrombotic effect of thrombin's direct inhibitors, antithrombin III and hirudin, as locally applied. Wistar rats were divided into four groups of 12 animals each. The carotid artery sustained a standardized crush-avulsion-type injury (groups B-D). A segment of the afflicted area was removed and replaced by a microvenous graft. Group A had no crush-avulsion injury inflicted; a microvenous graft replaced a simple resection from the center of the carotid artery. During microvascular anastomoses, normal saline (groups A and B), recombinant hirudin (group C), or antithrombin III (group D) were locally applied. Bleeding times were recorded, and patency tests were performed 20 min, 48 h, and 1 week after blood flow reestablishment. All grafts were harvested and examined histologically. Patency tests, 1 week postrevascularization, demonstrated that this experimental crush-avulsion injury model ensured low patency in group B (25%), whereas group A, which had no injury inflicted, achieved a 100% patency rate. The local application of hirudin and antithrombin III significantly increased bleeding times as well as the patency rate (92% and 75%, respectively) compared to group B. These findings indicate the efficiency of the experimental model and the potential use of thrombin's direct inhibitors in microvascular surgery.     

bFGF和硫糖铝加速组织扩张实验方法的建立

目的　研究碱性成纤维细胞生长因子 (bFGF)和硫糖铝加速组织扩张的可行性和机理。方法　用猪作为实验动物 ,制作持续恒压扩张模型 ,实验Ⅰ组在扩张器与组织之间注入bFGF和硫糖铝 ,实验Ⅱ组注入bFGF和生理盐水 ,对照组注入生理盐水 ,2次 /日 ,持续用药 7天 ;扩张完成后 3天行组织学检查 ,皮肤即时回缩率的测量 ,制作皮瓣。结果　实验Ⅰ组扩张器内注液量为 (1 4 3± 1 5 .2 2 )ml,实验Ⅱ组为 (1 2 2± 1 8.7)ml,对照组 (1 2 1± 2 0 .0 9)ml,统计分析发现实验Ⅰ组与实验Ⅱ组、对照组间有显著差别 (P <0 .0 5)。实验Ⅰ组扩张器表面组织表皮层增厚 ,成纤维细胞和毛细血管密度显著增高 ,实验Ⅱ组、对照组变化较弱。扩张后皮肤组织即时回缩率实验Ⅰ组明显小于对照组(P <0 .0 5) ,实验Ⅱ组稍小于对照组 ,无统计学意义 (P >0 .0 5)。皮瓣形成术后 4周实验Ⅰ组皮瓣伸展程度较对照组高 ,基本恢复正常 (P <0 .0 5) ,8周实验Ⅰ组皮瓣有增宽趋势 ;实验Ⅱ组与对照组差别无统计学意义。结论　bFGF和硫糖铝局部应用与持续恒压扩张术结合可以促进扩张组织增生 ,加速扩张 ,该动物实验方法简单 ,效果可靠     

The effect of chemical hemodynamic regulation on the survival of arterialized venous flaps

The role of nitric oxide (NO) on the microcirculation of arterialized venous flaps (AVFs) remains controversial. We aimed to investigate the effect of hemodynamic regulation using nitric oxide synthase (NOS) inhibitor and its agonist as a chemical intervention on the survival of AVF. A 10?×?8?cm arterialized venous flap was designed symmetrically on the rabbit abdomen. Thirty-six rabbits were used and randomly divided into three groups: control group, L-arg group and L-NAME group, respectively. The L-arg group and the L-NAME group received intraperitoneal injections of L-arginine (a NOS agonist, 1?g/kg/d) and L-NAME (nitro-L-arginine-methyl ester, a NOS inhibitor, 50?mg/kg/d) respectively, whereas the control group received intraperitoneal injections of the same amount of saline. Flap viability, water content, status of vascular perfusion and gene expression of eNOS and HIF-1α in each group were observed and analyzed. The average value of water content (venous congestion) in the L-arg group was the highest in comparison with the control group and the L-NAME group with a statistically significant difference (all p?相似文献