预处理在预防皮瓣缺血性损伤中的研究进展

The Effect of Preconditioning on Preventing Ischemic Injury of Skin Flaps

皮瓣缺氧缺血性损伤导致皮瓣坏死,一直是困扰整形外科的难题。皮瓣坏死是皮瓣缺血再灌注损伤的最终结果,涉及缺血、氧自由基损害、白细胞黏附和Ca2+超载等病理变化。因此,皮瓣坏死防治的关键在于改善血液循环、减轻炎症反应和防止或减轻缺血再灌注损伤。预处理是皮瓣手术前以改善组织生存和适应能力所采取的措施,旨在减少或防止皮瓣坏死。本文就金属硫蛋白、腺苷、阿霉素、热应激、高压氧、去铁胺等在预处理中的应用进行综述。

Hypoxic-ischemic injury leads to flap necrosis has always been a issue in the plastic surgery. Flap necrosis is the final result of the flap I/R injury. It consist of ischemia, hypoxia, oxygen free radical damage, white blood cell adhesion and Ca^2＋ overload, therefore the main method for avoiding flap necrosis is to improve the circulation of blood flow, reduce the inflammation reaction and prevent or lower the injury from I/R injury. Precondition with subsequent stress is defined as the flap organizations before the surgery to improve the organizational survival and adaptation of the tissue, so as to reduce or prevent flap necrosis. In this review, progress of precondition measures are summarized： metallothionein, adenosine, doxorubicin, heat shock protein, hyperbaric oxygen, Deferoxamine, flap survival.