CAJ | 학술논문

目的观察局部应用重组水蛭素对家兔耳静脉淤血皮瓣成活的影响.方法选取健康普通大耳白兔18只,按照随机数字表法分为对照组、低分子肝素治疗组、重组水蛭素治疗组,每组6只.各组家兔麻醉后在左耳背制作静脉淤血皮瓣模型:皮瓣大小为6 cm×3 cm,以耳中心动脉为惟一血供、1 cm宽蒂部为惟一静脉回流途径.术后分别于皮瓣下多点均匀注射 1 mL生理盐水、低分子肝素(625 U)、重组水蛭素(1 U),皮瓣原位缝合.观察皮瓣外观并计算成活率;术后1、3、5、7 d 取皮瓣远端组织检测血栓素B2含量.对数据行单因素方差分析、t检验.结果各组家兔皮瓣完全坏死区域毛发脱落明显;术后皮瓣均肿胀明显,远端淤血形成,对照组颜色明显深于2个治疗组.术后1 d 重组水蛭素治疗组1只家兔、低分子肝素治疗组2只家兔、对照组4只家兔出现明显血肿.低分子肝素治疗组、重组水蛭素治疗组家兔皮瓣成活率分别为(92.3±1.7)%、(94.8±1.9)%,均高于对照组[(77.9±1.2)%,F=191.29,P＜0.05].2个治疗组家兔皮瓣成活率接近(t=2.75,P>0.05).术后3、5 d,2个治疗组家兔血栓素B2含量均明显低于对照组(t值为6.68~30.55,P值均小于0.01),而2个治疗组家兔血栓素B2含量接近(t值分别为1.22、6.44,P值均大于0.05).结论局部应用低分子肝素或重组水蛭素,可明显改善家兔皮瓣的静脉淤血,提高皮瓣成活率.
목적 관찰국부응용중조수질소대가토이정맥어혈피판성활적영향.방법 선취건강보통대이백토18지,안조수궤수자표법분위대조조、저분자간소치료조、중조수질소치료조,매조6지.각조가토마취후재좌이배제작정맥어혈피판모형:피판대소위6 cm×3 cm,이이중심동맥위유일혈공、1 cm관체부위유일정맥회류도경.술후분별우피판하다점균균주사 1 mL생리염수、저분자간소(625 U)、중조수질소(1 U),피판원위봉합.관찰피판외관병계산성활솔;술후1、3、5、7 d 취피판원단조직검측혈전소B2함량.대수거행단인소방차분석、t검험.결과 각조가토피판완전배사구역모발탈락명현;술후피판균종창명현,원단어혈형성,대조조안색명현심우2개치료조.술후1 d 중조수질소치료조1지가토、저분자간소치료조2지가토、대조조4지가토출현명현혈종.저분자간소치료조、중조수질소치료조가토피판성활솔분별위(92.3±1.7)%、(94.8±1.9)%,균고우대조조[(77.9±1.2)%,F=191.29,P＜0.05].2개치료조가토피판성활솔접근(t=2.75,P>0.05).술후3、5 d,2개치료조가토혈전소B2함량균명현저우대조조(t치위6.68~30.55,P치균소우0.01),이2개치료조가토혈전소B2함량접근(t치분별위1.22、6.44,P치균대우0.05).결론 국부응용저분자간소혹중조수질소,가명현개선가토피판적정맥어혈,제고피판성활솔.
Objective To observe the effect of local injection of recombinant hirudin on survival of skin flaps with venous congestion in a rabbit model. Methods Eighteen healthy rabbits were enrolled and divided into heparin-treatment (HT),recombinant hirudin treatment (RHT) and control (C) groups according to the random number table,with 6 rabbits in each group. After intravenous anesthesia with 20 g/L pentobarbital sodium,model of skin flaps with venous congestion in the size of 6 cm×3 cm was reproduced in the dorsal side of left ear of each rabbit,in which central artery of ear served as the only blood supply,and a pedicle of 1 cm in width including central vessel of ear and its accompanying nerves as the only venous return pathway. Each flap in RHT,HT,C groups was respectively given 1 mL recombinant hirudin (1 U),low-molecular-weight heparin (625 U),and isotonic saline via multi-point and homogenous injection,then they were sutured in site. Appearance and survival rate of the flaps were observed after operation. Specimens of the distal part of flaps were harvested for determination of thromboxane B2 (TXB2) on post operation day (POD) 1,3,5,7. Data were processed with one-way analysis of variance and t test. Results Rabbit model of skin flaps with venous congestion was reproduced successfully. Obvious hair loss was observed in completely necrotic parts of flap in each group. Obvious edema was observed in all flaps with venous congestion at distal site. The color of flaps in HT and RHT groups were lighter as compared with that in C group,and apparent hematoma of flap was observed in 1 rabbit of RHT group,2 rabbits of HT group,4 rabbits of C group on POD 1. The survival rate of flap in HT and RHT groups was respectively (92.3±1.7)% and (94.8±1.9)%,both higher than that in C group[(77.9±1.2)%,F=191.29,P＜0.05]. There was no statistical difference in survival rate of flap between HT group and RHT group (t=2.75,P>0.05). The content of TXB2 in HT and RHT groups on POD 3,5 was respectively lower than that in C group (with t value from 6.68 to 30.55,P values all below 0.01),but there was no statistical difference between HT and RHT groups (with t value respectively 1.22,6.44,P values all above 0.05). Conclusions Local injection of low-molecular-weight heparin or recombinant hirudin can significantly ameliorate venous congestion of skin flap in rabbit ear,and improve its survival rate.