雌激素改善皮瓣再灌注损伤和血供的实验研究  

IMPROVEMENT EFFECT OF ESTROGEN ON FLAP REPERFUSION INJURY AND BLOOD SUPPLY

作　　者：徐瑞生[1] 葛建华[1] 雷玉凯[1] 鲁晓波[1] 

机构地区：[1]泸州医学院附属医院骨与关节外科,四川泸州646000

出　　处：《中国修复重建外科杂志》2009年第8期964-968,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川省教育厅重点资助项目(2004329)~~

摘　　要：目的研究不同剂量雌激素对皮瓣组织损伤、血供及成活面积的影响,并探讨其作用机制。方法取3～4月龄新西兰白兔30只,雌雄不限,体重1.5～2.2kg,制备以兔背中线为轴、蒂在头侧、大小为12cm×3cm的随意皮瓣,7d皮瓣断蒂。随机分为3组,每组10只。A、B组造模后2、4、6d于皮瓣近侧分别注射100、50μg/kg苯甲酸雌二醇注射液,深达皮下;C组不作处理,作为对照组。观察动物一般情况,并于注射完毕后3、7d行大体观察,7d测量皮瓣成活面积,5d测量血清丙二醛(malondialdehyde,MDA)及NO含量,4、7d切取皮瓣行组织学及免疫组织化学观察,行中性粒细胞(neutrophil,NEU)计数及VEGF评分。结果术中3组各1只动物因麻醉过量死亡,余存活至实验完成。造膜后3组动物皮瓣远端均出现不同程度发黑、变硬,其中C组较明显,无渗出,注射完毕后3d皮瓣皮温接近正常皮肤。注射完毕后7d,A、B、C组皮瓣成活面积分别为(13.71±2.91)、(12.80±1.99)及(10.12±1.43)cm2;术后5d,A、B、C组MDA含量分别为(4.02±0.85)、(3.99±0.77)及(4.89±0.75)nmol/mL,NO含量分别为(89.36±14.82)、(88.37±24.81)及(65.78±19.04)μmol/L。以上各指标A、B组与C组比较差异有统计学意义(P<0.05),A、B组间比较差异无统计学意义(P>0.05)。注射完毕后4d,A、B、C组NEU计数分别为(18.20±6.24)、(21.27±5.34)及(28.78±7.92)个/HP;注射完毕后7d分别为(15.16±7.02)、(18.12±6.44)及(29.67±9.12)个/HP,各组间比较差异有统计学意义(P<0.05)。注射完毕后4d,A、B、C组VEGF评分分别为(4.02±0.48)、(4.19±0.66)及(3.67±0.49)分;注射完毕后7d分别为(4.96±0.69)、(5.12±0.77)及(3.81±0.54)分。NEU计数及VEGF评分组内不同时间点比较A、B组间差异有统计学意义(P<0.05),C组差异无统计学意义(P>0.05);各时间点组间比较差异均有统计学意义(P<0.05)。结论雌激素注射可使皮瓣VEGF表达上调、NO含量增加、MDA含量降低、NEU浸润减少,增加皮瓣成�Objective To study the effect of various doses of estrogen on tissue injury, blood supply and survival area of skin flap and to investigate its mechanism. Methods Thirty New Zealand white rabbits aged 3-4 months old and weighing 1.5-2.2 kg （male or female） were used. Random pattern skin flap （12 cm × 3 cm in size） taking the central line of the rabbit dorsum as axis and with the pedicle attached at the proximal end was prepared, and the flap pedicle division was performed 7 days after operation. The rabbits were divided randomly into three groups （n=10 rabbits per group）. At 2, 4, and 6 days after operation, the proximal edge of flap in group A and B received 100 μg/kg and 50 μg/kg subcutaneous injection of estradiol benzoate, respectively, while group C received no further treatment serving as control group. General condition of the rabbits was observed after injection, gross observation was performed 3 and 7 days after injection, survival area of the skin flap was measured 7 days after injection, contents of malondialdehyde （MDA） and nitric oxide （NO） were tested 5 days after injection, and the flaps were harvested 4 and 7 days after injection to receive histology and immunohistochemistry observation, neutrophil （NEU） counting and VEGF scoring. Results All rabbits survived to the end of the experiment except 3 rabbits （1 rabbit per group） dying from anesthesia overdose. After operation the distal edge of flap in each group all demonstrated different degrees of darkening and hardening, especially group C, and no exudation was observed. Skin temperature of the flaps was close to that of normal skin 3 days after injection. The survival area of the skin flap 7 days after injection was （13.71 ± 2.91） cm^2 in group A, （12.80 ± 1.99） cm^2 in group B, and （10.12 ± 1.43） cm^2 in group C; at 5 days after injection, the MDA content was （4.02 ± 0.85） nmol/mL in group A, （3.99 ± 0.77） nmol/mL in group B, and （4.89 ± 0.75） nmol/mL in group C, and the NO content was

关 键 词：雌激素 皮瓣 成活面积 丙二醛 NO 兔 

分 类 号：R622.1[医药卫生—整形外科] R619.9[医药卫生—外科学]