天然水蛭素联合高压氧治疗对大鼠随意皮瓣成活的影响研究  

Effects of combined natural hirudin and hyperbaric oxygen therapy on survival of transplanted random-pattern skin flap in rats

作　　者：蔡洁云 林博杰[1] 潘新元 崔佳 Pradhan Rohan 殷国前[1] CAI Jieyun1, LIN Bojie1, PAN Xinyuan2, CUI Jia1, Pradhan Rohan1, YIN Guoqian1(1. Department of Plastic and Aesthetic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021 P.R.China 2. Department of Burn and Plastic Surgery, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning Guangxi, 530001, P.R. Chin)

机构地区：[1]广西医科大学第一附属医院整形美容外科,南宁530021 [2]广西壮族自治区民族医院烧伤整形外科,南宁530001

出　　处：《中国修复重建外科杂志》2018年第4期484-490,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：广西壮族自治区教育厅高校重点科研项目(ZD2014034);国家自然科学基金资助项目(81460297)~~

摘　　要：目的探讨天然水蛭素联合高压氧治疗对大鼠随意皮瓣成活的影响。方法取72只SD大鼠,于背部制备面积为10.0 cm×2.5 cm的随意皮瓣移植模型后,随机分为4组(n=18)。对照组术后即刻及之后4 d内注射生理盐水,高压氧组注射生理盐水同时行高压氧治疗,水蛭素组仅注射天然水蛭素,联合组注射天然水蛭素同时行高压氧治疗。术后大体观察皮瓣成活情况,第6天计算皮瓣成活率;第2、4天取材,HE染色观察皮瓣组织学变化;免疫组织化学染色检测皮瓣微血管密度(microvessel density,MVD)以及TNF-α表达水平。结果术后各组皮瓣均出现部分坏死,其中联合组皮瓣成活最佳;术后第6天高压氧组、水蛭素组及联合组皮瓣成活率明显高于对照组,联合组高于水蛭素组、高压氧组,比较差异有统计学意义(P<0.05);水蛭素组与高压氧组比较,差异无统计学意义(P>0.05)。组织学观察示,术后第2天,水蛭素组、高压氧组及联合组微血管结构较对照组多,各组均见炎性细胞浸润;第4天,高压氧组、水蛭素组及联合组中仍可见较多微血管形成,对照组中见大量炎性细胞浸润,其余各组炎性细胞均较术后第2天时明显减少。免疫组织化学染色观察示,术后第2天,高压氧组、水蛭素组及联合组MVD均显著高于对照组、TNF-α蛋白表达量显著低于对照组(P<0.05);高压氧组、水蛭素组及联合组以上指标比较,差异无统计学意义(P>0.05)。术后第4天,高压氧组、水蛭素组及联合组MVD均显著高于对照组,联合组及水蛭素组高于高压氧组,比较差异有统计学意义(P<0.05),联合组及水蛭素组间比较差异无统计学意义(P>0.05);高压氧组、水蛭素组及联合组TNF-α蛋白表达量显著低于对照组,联合组低于水蛭素组及高压氧组,比较差异有统计学意义(P<0.05),水蛭素组及高压氧组间比较差异无统计学意义(P>0.05)。结论高压氧和天然水蛭素干预均能提高随�ObjectiveTo investigate the effect of natural hirudin combined with hyperbaric oxygen therapy on the survival of transplanted random-pattern skin flap in rats.MethodsA random-pattern skin flap in size of 10.0 cm×2.5 cm was elevated on the dorsum of 72 Sprague Dawley rats. Then the 72 rats were randomly divided into 4 groups （n=18） according to the therapy method. At immediate and within 4 days after operation, the rats were treated with normal saline injection in control group, normal saline injection combined with hyperbaric oxygen treatment in hyperbaric oxygen group, the natural hirudin injection in natural hirudin group, and the natural hirudin injection combined with hyperbaric oxygen treatment in combined group. The flap survival was observed after operation, and survival rate was evaluated at 6 days after operation. The skin samples were collected for histological analysis, microvessel density （MVD） measurement, and evaluation of tumor necrosis factor α （TNF-α） expression level by the immunohistochemical staining at 2 and 4 days after operation.ResultsPartial necrosis occurred in each group after operation, and the flap in combined group had the best survival. The survival rate of flap was significantly higher in hyperbaric oxygen group, natural hirudin group, and combined group than that in control group, and in combined group than in hyperbaric oxygen group and natural hirudin group （P〈0.05）. There was no significant difference between hyperbaric oxygen group and natural hirudin group （P〉0.05）. At 2 days, more microvascular structure was observed in hyperbaric oxygen group, natural hirudin group, and combined group in comparison with control group; while plenty of inflammatory cells infiltration in all groups. At 4 days, the hyperbaric oxygen group, natural hirudin group, and the combined group still showed more angiogenesis. Meanwhile, there was still infiltration of inflammatory cells in control group, inflammatory cells in the other groups were significantly reduced when com

关 键 词：水蛭素 高压氧 随意皮瓣 血管生成 炎性反应 皮瓣成活 大鼠 

分 类 号：R622[医药卫生—整形外科]