岛状皮瓣静脉淤血再通后对大鼠全身情况的影响

目的：探讨岛状皮瓣静脉淤血再通后对全身多脏器的影响。方法：按静脉淤血时间的不同将大鼠分为4组。观察耳部微循环的改变，测量术后肿瘤坏死因子α(TNFα），白细胞介素10（IL－10）的动态变化，观察心，肺，肝，肾，小肠及耳部血管等组织结构及中性粒细胞浸润数目。结果：皮瓣原位缝合组及静脉淤血2h组，耳部微循环、TNFα、IL-10浓度基本保持不变，各脏器结构改变较轻，中性粒细胞浸润数目少。静脉淤血6、10h组，微循环，肺，小肠，血管则有明显组织学改变，大量中性粒细胞浸润其中，但心，肝，肾组织学改变较轻。TNFα浓度再灌注1h达到高峰，其后逐渐下降，IL－10浓度3h达到最低，然后逐渐上升。结论：皮瓣静脉淤血再通后可造成肺、小肠及血管器官损伤，静脉淤血时间越长，再通后则损伤程度越重。全身微循环的改变，中性粒细胞在肺、小肠中的浸润，与血管内皮细胞的粘附及细胞因子TNFα与IL－10的浓度失衡是重要的操作原因。

Systemic influence after an island flap with venous congestion-reperfusion injury

OBJECTIVE: To investigate the systemic influence after an island flap with venous congestion-reperfusion. METHODS: An island flap was formed in a Rat model. The vein in the pedicle was clamped for 2 hours, 6 hours and 10 hours and released. The ear microcirculation, levels of TNF alpha and IL-10 were measured, and the neutrophils sequestration in tissues were counted. The vascular structure of the lung and intestine were evaluated. RESULTS: There were significant changes in the ear microcirculation, neutrophils sequestration of the lung and the intestine in the 2 hours, 6 hours and 10 hours groups, and became more serious by the time increasing. The TNF alpha level reached in maximum at 1 hour after the reperfusion, while the IL-10 became to the lowest level at 3 hours after the reperfusion. However, the TNF alpha and IL-10 levels were significant high in the 6 hour and 10 hours groups, compared with the 2 hours group and the control, but there was no differences between the2 hours group and the control. CONCLUSIONS: Venous congestion-reperfusion of flap could injury the remote organs such as lung, intestinal etc. The injury could be more serious with the time increasing.