不同灌注液对人离体小动脉保护作用的超微观察

目的 研究不同灌注液对离体小动脉超微结构的影响.方法 对手指近端毁损伤,缺乏再植条件或患者放弃再植的18指近节离断手指(热缺血时间＜2 h),分成3组,每组6指,分别在指动脉内灌注能量合剂(A组)、肝素钠+1%利多卡因(B组)和生理盐水(C组),4℃保存.分别于灌注后2、4 6 8、12、16、24 h切取指动脉3 mm,固定后切片电镜下观察小动脉在不同时间段超微结构的变化.另取离断指体近端未缺血的健康指动脉3 mm直接固定,为对照组.结果 电镜下观察:A组灌注8 h后,小动脉平滑肌细胞线粒体仅轻度肿胀,嵴变短.B组灌注4 h后,线粒体明显肿胀和内质网扩张;8 h后,血管平滑肌细胞内线粒体进一步肿大,嵴稀疏.C组灌注2 h后,内皮细胞轻度肿胀,少数脱落;4 h后,内皮细胞肿胀,部分脱落,血管平滑肌细胞内线粒体开始肿大;8 h后,血管平滑肌细胞内线粒体进一步肿大,部分出现空泡,嵴减少,基质变淡.与A组和C组比较,小动脉经肝素钠+利多卡因灌注后内皮细胞脱落延迟至16 h.结论 能量合剂灌注液对离体小动脉的超微结构有保护作用,能够减轻肢体缺血再灌注损伤的程度.

Effect of energy compounds perfusion on the ultrastructures of digital artery in human: an in vitro study

Objective To study the influence of various perfusion solutions on the uhrastructures of small arteries. Methods Eighteen amputated fingers(proximal phalanx level.warm ischemia time＜2 hours)that were considered non-replantable were used in the study.They were divided into 3 groups with 6 each and peffused via the digital artery with energy compounds(group A),1%lidocaine+heparin(group B),and normal saline(group C).The fingers were preserved at 4℃.A 3 mm segment of digital artery was harvested 2,4,6,8,12,16 and 24 hours after perfusion and processed.The sections were observed under electron microscope to evaluate changes in ultrastructures of the small artery.A 3 mm segment of healthv nonischemic digital artery at the proximal finger stump was harvested and served as control. Results The uhrastructural changes in small digital artery perfused with saline were more severe and developed faster then that perfused with energy compounds.There was only slight swelling of smooth muscle cell mitochondria 8 hours after perfusion in group A.Obvious mitochondria swelling and expansion of endoreticulum was seen 4 hours following perfusion in group B.Progressed swelling of smooth muscle cell mitochondria was observed in this group 8 hours after perfusion.In group C slight swelling and detachment of endothelial cells was seen 2 hour after perfusion.4 hours following perfusion more severe endothelial swelling and detachment was noticed.Mitochondria swelling along with vacuole formation and reduced ridges was also seen.Compare to group A and C.lidocaine+heparin call delay endothelial detachment to 16 hours after perfusion. Conclusion Energy compounds has protective effects on uhrastructures of small arteries and call reduce the severity of ischemiareperfusion injury.