肢体缺血再灌流对胫前筋膜间隔压力影响的实验研究

为了观察肢体不同缺血时间再灌流后筋膜间隔的压力变化以及与血清丙二醛（ＭＤＡ）、血清肌酸液酶（ＣＰＫ）含量变化的关系,观察甘露醇对肢体缺血再灌流的保护作用,作者将１８只新西兰兔分成３组,分别观察各组术前、缺血即时、缺血期末、再灌流４、２４、７２小时筋膜间隔的压力变化以及血清ＭＤＡ、ＣＰＫ的含量变化和骨骼肌的组织学变化。结果显示：缺血时间越长,组织损伤越重,再灌流后损伤进一步加重,以再灌流２４小时到达顶点,血清ＭＤＡ、ＣＰＫ均达峰值,与筋膜间隔的压力变化一致。应用甘露醇组的变化则明显减轻。实验结果表明,肢体缺血再灌流可以导致筋膜间隔的压力增高,从而使损伤进一步加重,这种损伤以再灌流后２４小时最为严重,而甘露醇可以明显减轻组织的损伤和降低筋膜间隔的压力。

Experimental study on the effect of extremities ischemia reperfusion inducing anterior tibial compartment pressure

We observed the changes of compartment pressure after extremities were reperfused at different intervals of ischemia and its relatiomship with the changes of serum MDA and CPK content.The protective effect of mannite on extremities ischemia reperfusion was also studied.18 New Zealand rabbits were separated into three groups:group A (ischemia 4h);group B (ischemia 8h);group C (ischemia 4h).The rabbits of group A and B were intravenous injected with normal saline (NS), and group C was injected with 20% mannite.The changes of compartment pressure of serum MDA and CPK content and the histological changes of skeletal muscles in every group were noted at different times: preoperation; the beginning of ischemia; the end of ischemia and reperfusion for 4h; 24h; 72h, respectively. The longer ischmia lasted, the more serious the tissue damage was.Reperfusion made tissue damaged further. After reperfusion for 24h, the damage was the most serious. Meanwhile, the serum MDA and CPK content also reached the peak value. These changes were in accord with those of compartment pressure.On the other hand, the damage of mannite group was relatively mild.Extremity ischemia reperfusion would led to the increase of compartment pressure, then intensified the damage . The damage was the most serious at 24h of reperfusion. Using mannite could reduce the tissue damage and compartment pressure. Mannite should be recommended as the first selected drug for extremity ischemia reperfusion injury.