经导管动脉溶栓治疗严重冻伤的基础研究

目的探究经导管动脉灌注复方丹参注射液治疗新西兰白兔严重冻伤模型的有效性及机制。 方法36只新西兰白兔的严重冻伤模型随机分成3组，A组：常规溶栓组（t-PA +肝素+罂粟碱）；B组：改良溶栓组（t-PA +肝素+罂粟碱+复方丹参注射液）；C组：对照组（生理盐水），各组均于溶栓后24 h进行患肢动脉造影并评估应答，进行血常规、凝血及纤溶活性指标、血栓素B2、6-酮-前列腺F_1α、丙二醛、超氧化物歧化酶检测并进行组间比较。每组剩余2只模型行受累肢端组织病理学检查。采用截趾率和得分法进行统计最终截肢率并进行组间比较。 结果A、B、C组模型的血管造影应答中完全缓解分别为3、0、0例，大部分缓解分别为4、2、0例，轻度缓解分别为2、4、2例，无缓解分别为1、4、8例。各组间模型WBC数量比较具有显著性差异（P值均< 0.05）；RBC、HGB、HCT比较无显著性差异（P值均> 0.05）；A、B组模型的血小板数量明显高于C组（P值均< 0.05）；A、B组模型的PT、APTT显著地长于C组（P值均< 0.05）；A、B组模型的FIB显著地低于C组（P值均< 0.05）；B组模型的血浆6-酮-前列腺F_1α、超氧化物歧化酶含量显著地高于A和C组（P值均< 0.05）；B组模型的血浆血栓素B2、丙二醛含量显著地低于A和C组（P值均< 0.05），A、B、C组模型截趾率分别为46.9%、22.5%、85.0%，得分法分别为9.5 ± 2.7、4.3 ± 1.1、21.8 ± 4.2；各组间模型截趾率及得分比较均有显著性差异（P值均< 0.05）。 结论复方丹参注射液可显著降低新西兰白兔严重模型的截趾率，可能的机制是复方丹参注射液可纠正严重冻伤后机体的PGI2-TXA2及氧化-抗氧化失衡。

The basic study of transcatheter intra-arterial thrombolysis in the treatment of severe frostbite

ObjectiveTo explore the efficacy and mechanism of transcatheter arterial compound Danshen injection infusion in the treatment of severe frostbite in New Zealand white rabbits. Methods36 New Zealand white rabbits with severe frostbite underwent routine rewarming and were randomly divided into 3 groups, Group A: conventional thrombolytic group (t-PA + heparin + papaverine), B Group: modified thrombolytic group (t-PA + heparin + papaverine + compound Danshen injection), group C: control group (normal saline). Severe frostbite model of 10 New Zealand white rabbits in each group were assessed by angiographic response 24 hours after thrombolytic therapy. Blood routine, coagulation and fibrinolytic activity indicators, TXB2, 6-keto-PGF1α , MDA, SOD were measured and compared between groups.The remaining 2 rabbits in each group were performed histopathological examination, the final amputation was analyzed by toe amputation rate and scoring method and compared between groups. ResultsComplete response in angiographic assessment in group A, B and C occured in 3, 0, 0 cases, majority response in 4, 2, 0 cases, mild response in 2, 4, 2 cases, no response in 1, 4, 8 cases. There was significant difference in the number of WBCs among all groups after thrombolytic therapy (P < 0.05). There was no significant difference in RBC, HGB and HCT (P > 0.05). The number of platelets in group A and group B was significantly higher than that in group C (P < 0.05). PT and APTT in group A and group B were significantly longer than those in group C (P < 0.05). FIB in group A and group B was significantly lower than that in group C (P < 0.05). The levels of plasma 6-keto-PGF1α and SOD in group B were significantly higher than those in group A and C (P < 0.05). The levels of TXB2 and MDA in group B were significantly lower than those in group A and C (P < 0.05). The toes amputation rates of group A, B and C were 46.9%, 22.5% and 85.0% respectively. The results of scoring method were 9.5 ± 2.7, 4.3 ± 1.1 and 21.8 ± 4.2 respectively. There were significant differences in amputation rate and score among all groups (P < 0.05). ConclusionsCompound Danshen injection can significantly reduce the rate of toe amputation in severely frostbitten rabbits, the possible mechanism may be that compound Danshen injection can correct the PGI2-TXA2 and oxidation-antioxidation imbalance.