任意皮瓣局部注射血管内皮生长因子对其抗菌力影响的实验研究

Effect of vascular endothelial growth factor on the resistance against infection in random pattern skin flap

目的探讨血管内皮生长因子(VEGF)对皮瓣抗菌力的影响。方法选用60只SD大鼠,制作背部6cm×4 cm任意皮瓣的动物模型。术中VEGF组局部注射VEGF1.0μg/瓣,对照组注射等量生理盐水。术后即刻注射铜绿假单胞菌。结果①术后第5天VEGF组白细胞吞噬指数(0.12±0.02)较生理盐水对照组(0.08±0.03)高,差异有显著意义(P<0.05);细胞内杀菌率VEGF组(78.58±1.63)%较生理盐水对照组(36.17±2.31)%高,差异有显著意义(P<0.01)。②术后第11天VEGF组皮瓣存活面积为(66.06±5.05)%较生理盐水对照组(50.15±4.46)%大,差异有显著意义(P<0.01)。③同一时相内肉眼及光镜观察,VEGF组皮瓣各段的病理改变较轻,真皮层发现较多毛细血管,炎细胞浸润较少。④术后第11天皮瓣在100低倍镜视野计算血管密度,VEGF组(35.64±5.41)/cm2较生理盐水对照组(16.42±4.13)/cm2高,差异有显著意义(P<0.01)。结论VEGF能改善皮瓣微循环、促进血管再生,有明显的促进任意皮瓣成活、抗感染作用。

Objective To study the effect of vascular endothelial growth factor （VEGF） on the resistance against infection in skin flap. Methods 60 Sprague - Dawley rats with randomized flap measuring 6 cm × 4 cm created on the back, were divided into 2 groups （ n = 30 each）： a treatment group to receive VEGF 1.0 μg/flap during the operation and a control group receiving equal volume of normal saline. Pseudomonas aeruginosa bacteria was inoculated immediately after the operation to observe the infection. Results ① The phagocytic activity was higher in the treatment group than in the control group （0.12±0.02 vs. 0.08±0.03, P 〈0.05）, and the intracellular bacterial killing ratio was higher in the treatment group than in the control group [ （ 78.58±1.63 ）% vs. （ 36.17± 2.31 ）%, P 〈 0.01 ]. ②The survival area of flap on the 11 th postoperative day was bigger in the treatment group [ （ 66.06± 5.05 ）% vs. （ 50. 15±4.46）%, P 〈0.01].③ Gross and microscopic pathological changes in VEGF treated group were fewer than in the control group; there were abundant capillaries and fewer inflammatory cells in the VEGF group.④ The vascular density in flap of the treatment group was increased on the 11 th day [ （35.64±5.41 ）/cm^2 vs. 16.42 ± 4.13 ）/cm^2, P 〈 0.01 ]. Conclusion Vascular endothelial growth factor （VEGF） can improve the flap micro-circulation and increase its vascularization, playing important roles in improving flap survival and resisting infection in the flap.