体外循环加压灌注重建肢体微循环的力学与化学信号传导机制  

Extracorporeal circulation compression perfusion in the reconstruction of limb microcirculation from the mechanism of mechanical and chemical signal transduction

作　　者：高磊 秦新愿 聂鑫 王雷 王江宁 Gao Lei;Qin Xinyuan;Nie Xin;Wang Lei;Wang Jiangning(Department of Orthopedics,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Orthopedics,First Affiliated Hospital of Shandong First Medical University,Jinan 250014,Shandong Province,China;Department of Emergency,Second Hospital of Shandong University,Jinan 250033,Shandong Province,China)

机构地区：[1]首都医科大学附属北京世纪坛医院矫形外科,北京市100038 [2]山东第一医科大学第一附属医院骨创科,山东省济南市250014 [3]山东大学第二医院急诊科,山东省济南市250033

出　　处：《中国组织工程研究》2022年第9期1334-1340,共7页Chinese Journal of Tissue Engineering Research

基　　金：首都临床特色应用研究与成果推广项目(Z171100001017070),项目负责人:王江宁。

摘　　要：背景:前期工作应用体外循环加压灌注治疗缺血病变,建立下肢侧支循环的同时,通过增多下肢血流灌注量改善肢体远端微循环,该项技术取得了很好的临床效果。目的:通过设计糖尿病合并外周动脉疾病动物模型,从力学与化学信号传导机制来阐述体外循环加压灌注技术重建肢体微循环的作用原理。方法:24只巴马小型猪(均建立糖尿病合并外周动脉疾病模型),随机分为4组,每组6只,分别为空白对照组、模型组、体外循环灌注治疗组(正常肢体平均动脉压灌注)(常压灌注组)、体外循环加压灌注治疗组(2倍平均动脉压灌注)(加压灌注组),分别于模型建立成功、灌注30 min,1 h,2 h,5 h,7 h等6个时间点测定4组实验动物的肢体血流量,抽取实验动物动脉血运用ELISA法行细胞因子白细胞介素8、一氧化氮和内皮素1含量测定;实验结束2周后,取右后肢胫前肌组织,于病理科行苏木精-伊红染色,观察毛细血管密度;实验结束后取4组实验动物右后肢胫前肌组织,Western blot法检测组织中血管内皮生长因子A/血管内皮细胞生长因子受体2蛋白相对表达量。结果与结论:①加压灌注组在灌注7 h后,其皮肤血流值显著高于其他3组,差异有显著性意义(P<0.05);血清标本中一氧化氮水平显著高于其他3组,差异有显著性意义(P<0.05);血清标本中内皮素1值高于模型组,低于空白对照组、常压灌注组,差异有显著性意义(P<0.05);血清标本中白细胞介素8水平高于模型组,低于空白对照组、常压灌注组,差异有显著性意义(P<0.05);②实验结束2周后,加压灌注组胫前肌组织标本病理学检测显示微血管密度计数为(18.33±1.51)条/mm2,显著高于其他3组(P<0.05);加压灌注组胫前肌组织中血管内皮生长因子A/血管内皮细胞生长因子受体2蛋白表达量显著升高,与其他3组比较差异有显著性意义(P<0.05);③提示体外循环加压灌注技术通过提高�BACKGROUND:Preliminary work applied extracorporeal circulation and pressurized perfusion to treat ischemic lesions.While establishing lower extremity collateral circulation,it also improved the distal microcirculation of the extremities by increasing the blood perfusion volume of the lower extremities.This technique has achieved good clinical results.OBJECTIVE:To explain the principle of extracorporeal circulation compression perfusion in the reconstruction of limb microcirculation from the mechanism of mechanical and chemical signal transduction by designing an animal model of diabetes with peripheral arterial disease.METHODS:The models of diabetes mellitus complicated with peripheral arterial disease were established in 24 Bama miniature pigs and were randomly divided into four groups(n=6):blank control group,model group,extracorporeal circulation perfusion group(close to normal limb mean arterial pressure perfusion)(normobaric perfusion group),and extracorporeal circulation compression perfusion group(twice mean arterial pressure perfusion)(compression perfusion group).The limb blood flow of the four groups of experimental animals was measured at six time points:successful establishment of the model,30 minutes of perfusion,1 hour of perfusion,2 hours of perfusion,5 hours of perfusion,and 7 hours of perfusion.Arterial blood samples of experimental animals were taken to detect the contents of interleukin-8,nitric oxide and endothelin-1 by enzyme-linked immunosorbent assay.Two weeks after the end of the experiment,the tibialis anterior muscle of the right hindlimb was stained with hematoxylin and eosin to observe the capillary density.The tibialis anterior muscle of the right hindlimb was taken from the right hindlimb,and the relative expression of vascular endothelial growth factor A/vascular endothelial growth factor receptor 2 protein was detected by western blot assay.RESULTS AND CONCLUSION:(1)The skin blood flow of the compression perfusion group was significantly higher than that of other three groups after

关 键 词：糖尿病合并外周动脉疾病 体外循环加压灌注 微循环 剪切力 毛细血管 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]