血管内皮生长因子和L-精氨酸联合作用于大鼠缺血皮瓣的实验研究

目的观察血管内皮生长因子（VEGF）和一氧化氮（NO）联合作用对大鼠缺血皮瓣成活率的影响。方法建立大鼠背部随意和腹部带血管蒂缺血皮瓣两种动物模型，肉眼观察，使用图像分析技术，组织学观察，免疫组织化学分析，术后7d观察皮瓣成活面积，中性粒细胞浸润和皮瓣皮下平均血管数目及内径。结果VEGF、L—arginine、VEGF＋L—arginine和对照组（生理盐水组）皮瓣成活率分别为：（79．23±1．86）％及（69．97±1．14）％、（75．55±1．45）％及（68．62±2．27）％、（86．27±2．81）％及（76．08±1．10）％、（56．75±7．19）％及（50．62±1．34）％；四组皮瓣皮下平均血管数目各为：102．33±6．36及99．76±2．23、91．67±2．93及90．57±3．51、121．33±2．98及118．79±2．72、84．08±1．96及82．59±0．78：四组中性粒细胞计数分别是：40．91±2．85及44．64±2．49、32．43±2．35及36．41±1．90、28．33±2．58及30．74±3．24、114．12±6．15及125．90±6．74。VEGF＋L—arginine组与其他各组比较均有显著性差异（P〈0．01）。免疫组织化学分析显示用药组相对对照组有药物沉淀。结论VEGF和L-精氨酸联合使用能起到协同作用，与单一使用VEGF和L-精氨酸比较能提高缺血性皮瓣的成活率。

Experimental Study on Treatment of Isehemia Skin Flap of Rat with Vascular Endothelial Growth Factor Plus L-arginine

Objective To investigate the influence and mechanism of VEGF and L-arginine on the survival ofischemia skin flap of rat. Methods The animal models of random and pedicle flap were established. Experimental animal were divided into four groups ： VEGF, L-arginine, VEGF plus L-arginine and control group. The color, texture, temperature and capillary recirculation of skin flaps were investigated each day after operation. On day 7, survival areas of the skin flaps were calculated by computer image analysis software system. 7 days after operation, variance of histology, neutrophil counts, subdemic vascular number were evaluated under the microscope. The evidence of NO and VEGF expression was detected by immunohistological method. Results Tissue survival rates of the four groups were 79.23 ± 1.86% and 69.97 ± 1.14%, 75.55 ± 1.45% and 68.62 ± 2.27%, 86.27 ± 2.81% and 76.08 ±1.10%, 56.75 ± 7.19% and 50.62 ± 1.34%, normal staining documented that average vessel number of the four groups was 102.33± 6.36 and 99.76 ± 2.23,91.67 ± 2.93 and 90.57 ±3.51,121.33 ± 2.98 and 118.79 ± 2.72,84.08 ± 1.96 and 82.59 ± 0.78, neutrophil counts were 40.91 ± 2.85 and 44.64 ± 2.49, 32.43 ±2.35 and 36.41±1.90,28.33± 2.58 and 30.74±3.24,114.12±6.15 and 125.90± 6.74. There was significant difference between VEGF plus L-arginine group and other groups （P 〈 0.01）. Immunohistochemical staining showed increased deposition in medication groups compared with that in the control group. Conclusion VEGF plus L-arginine can enormously enhance the survival rate of the ischemic skin flap compared with the single medicine. There was synergistic action between the two.