皮瓣掀起后内皮素、一氧化氮变化与微循环关系的实验研究

Correlation between endothelin,nitric oxide and microcirculation in super-thinned skin flap in pig

目的 研究皮瓣掀起后内皮素 (ET)、一氧化氮 (NO)动态变化与皮瓣微循环的关系 ,并探讨ET、NO在真皮下血管网皮瓣超长成活中的作用。方法 在猪背部制备真皮下血管网皮瓣和任意型皮瓣 ,术前、术后测定皮瓣组织ET、NO含量及微循环血量。结果 两组皮瓣ET、NO量术后 1h开始明显上升 ,NO 3h达到峰值 ,ET 6h达到峰值 ;术后 1 ,3,6hET量在任意型皮瓣组上升更显著 (P <0 0 5) ,而NO量在真皮下血管网皮瓣组上升更显著 (P <0 0 5)。两组皮瓣术后微循环血量急剧下降 ,1h左右下降至最低 ;任意型皮瓣组微循环血量术后 1 ,3,6h下降幅度明显大于真皮下血管网皮瓣组 (P <0 0 1 )。任意型皮瓣组术后 1 ,3h微循环血量与ET量成显著负相关 (g =-0 776,P <0 0 1 ) ;与NO量成显著正相关 ( g =0 853,P <0 0 1 )。术后 7d观察真皮下血管网皮瓣成活长度较任意型皮瓣多 35%。结论 皮瓣掀起后ET、NO动态变化与皮瓣微循环密切相关 ,真皮下血管网皮瓣超长成活的因素之一可能是ET合成较少 。

Objective To investigate the influence of the endothelin (ET) and the nitric oxide (NO) on the microcirculation of a super\|thinned skin flap.Methods With pig,a super\|thinned skin flap,only including subdermal vascular networks,was raised and sutured back on its bed on one flank of each pig,and on the other flank a traditional skin flap was also formed for the controlled group. A laser Doppler Flowmeter was used for evaluation of the blood circulation before and after the operation. The endothelin and the nitric oxide of the flap were examined after certain times of the operation. Furthermore,the necrosis of each flap was decided 7 days after the operation. Results The ET and NO were significantly increasing after 1 hour of the operation in both of the groups (the peak value of ET at 6 hours and NO at 3 hours after the operation). However,the ET in the super\|thinned flap group was significantly lower at 1,3,6 hours after the operation,compared with the centrolled group ( P <0.05),but the NO measured meantime was significantly higher than the control ( P <0.05). The blood flow of the super\|thinned flap was significantly higher than the control flap separately at 1,3,6 hours after the operation ( P <0.01). The survival of the super\|thinned flap increased about 35% more than the control. There was a negative correlation existed between the ET and the blood flow,as well as a positive correlation between the NO and the blood flow. Conclusion This study has indicated that the changes of the ET and NO in the flaps,especially in the super\|thinned flap,have strongly correlated with their microcirculation. The highter survival rate of the super\|thinned flap might owes to the mechanism which the ET in the flap produces less while the NO more,Compared with the traditional skin flap.