巴曲亭与电灼对外膜剥离后的兔颈动脉修复的影响

Effects of batroxobin and electric cauterization on vascular remodeling of rabbit with a removal of carotid arterial adventitia

目的观察局部应用巴曲亭、电灼止血对新西兰兔颈动脉外膜剥离渗血模型中血管修复的影响。方法27只家兔按数字表法分为对照组、巴曲亭组及电灼组，采用酶消化＋钝性剥离去除颈动脉外膜造成渗血模型后，分别用巴曲亭（2kU／L），电灼（40w）及盐水纱布进行止血。术后0、14及28d后取出颈动脉，用HE、Masson染色及透视电镜观察外膜剥离后动脉的修复情况，逆转录-聚合酶链反应（RT—PCR）法及免疫组化法检测动脉单核细胞趋化蛋白-1（MCP．1）、转化生长因子-B1（TGF—B1）及血管内皮生长因子（VEGF）的表达情况。结果术后28d巴曲亭组和电刀组术后动脉重塑指数为（0．753±0．0739）和（0．6184-0．0989），狭窄率为（0．298±0．030）％和（0．363±0．039）％，胶原纤维密度为（15．4±3．5）％和（23．4±5．1）％，两组差异均有统计学意义（均P〈0．05）；而巴曲亭组与对照组比较差异无统计学意义；电镜观察见电灼组动脉成纤维细胞较巴曲亭组明显增多；RT—PCR及免疫组化显示术后14、28d，巴曲亭组MCP-1、TGF—β1及VEGF表达均低于电灼组（P〈0．05），而与对照组比较差异无统计学意义。结论在动脉外膜剥离渗血模型中，巴曲亭止血可有效减轻损伤血管的炎症反应，降低血管重塑程度和狭窄情况，和单纯的盐水纱布止血血管修复结果一致，是一种安全、有效、更接近自然状况的局部止血药物。

Objective To explore the topical hemostatic effects of batroxobin （BX） and electric cauterization （EC） on capillary hemorrhage of rabbit with a removal of carotid arterial adventitia. Methods A total of 27 New Zealand rabbits were randomly divided into control, BX and EC groups. Each group received BX （2 kU/L） , EC （power = 40 W） and saline for topical hemostasis after a removal of carotid arterial adventitia and blunt dissection. The animals were euthanized by 0, 14 and 28 d post-operation. The specimens of adventitia removal section were divided into three parts for histology （ hematoxylin and eosin, MASSON ＆ transmission electron microscope ） , immunohistochemistry （IHC） [ monocyte chemoattraetant protein-1 （MCP-1）, transforming growth factor-[31 （TGF-131） and vascular endothelial growth factor （VEGF） ] and reverse transcription-polymerase chain reaction （RT-PCR）. Results At Day 28 post- operation, the remodeling index, stenotie rate and collagen fiber density of BX and EC groups were （0.753±0.0739） and （0.618±0.0989）, （0.298±0.030）% and （0.363±0.039）%, （15.4±3.5 ） % and （ 23.4±5.1 ） % respectively. There was statistically significant difference between two groups （ P 〈 0.05） while no difference existed between hemocoagulase and control groups. The results of electron microscopy showed that the atrial fibroblasts of EC group increased markedly versus BX group. As demonstrated by RT-PCR and IHC, the expressions of MCP-1, TGF-β1 and VEGF in BX group were lower than those in EC group （ P 〈 0.05 ） while no difference versus the control group. Conclusion As a safe and effective topical hemostatic method, BX can effectively decrease inflammation response and reduce vascular remodeling and narrowing in rabbits with a removal of carotid arterial adventitia. And its effect mimic closely natural conditions.