UW液动脉预灌洗对缺血肢体再灌注损伤的影响

Washout with UW Solution to Relieve Limb of Ischemia-Reperfusion Injury

[目的]评估UW液动脉预灌洗对缺血肢体I/R损伤程度的影响,寻找减轻缺血组织I/R损伤的有效方式.[方法]建立大鼠后肢缺血模型,预灌洗组于肢体恢复血供前,应用UW液预灌洗30 min,然后恢复血供;缺血再灌注组不进行预灌洗直接恢复肢体血供,每组8只.通过监测骨骼肌再灌注血流量变化,测定血清CPK、LDH含量及骨骼肌水含量、MDA含量、SOD活性、骨骼肌细胞凋亡情况以及骨骼肌的超微结构改变,来评估骨骼肌的I/R损伤程度.[结果]恢复血供后,I/R组中骨骼肌血流过度灌注明显,峰值为健侧（216±22）％;随后血流量下降明显;UW组中未见过度灌注现象,血流灌注量维持平稳.恢复灌注2h,UW组中血清酶含量较I/R组降低20％～30％（P＜ 0.05）,而灌注4h和6h,两组间差异无统计学意义（P＞0.05）.缺血4 h,UW组中骨骼肌水含量、MDA含量和SOD活性与I/R组比较差异有统计学意义（P＜0.05）,但恢复灌注6h,两组间比较差异无统计学意义（P＞0.05）.UW液动脉预灌洗可有效抑制细胞的凋亡,维持骨骼肌超微结构的完整.[结论]UW液动脉预灌洗对减轻缺血肢体I/R损伤是一种可行的治疗方式,但其保护效果仍有待提高.

[Objective] To assess the effect of intraarterial washout with UW solution for skeletal muscle preservation during ischemia and reperfusion.[Methods] Ischemic rat limbs were perfused with UW solution for 0.5 h before reperfusion; controls received no perfusion.Serum CPK and LDH were measured pre-ischemia and after reperfusion （2 h,4 h,and 6 h）.Muscle water content,MDA,and SOD were assessed pre-reperfusion and after 6 h reperfusion.Apoptosis and ultrastructure in skeletal muscle were detected after 6 h reperfusion.Reperfusion blood flow was monitored during reperfusion period.[Results] Intraarterial washout with UW could prevent skeletal muscle luxury perfusion occurring,inhibit the apoptotic nuclei in skeletal muscle,and preserve skeletal muscle ultrastructural integrity after 6 h of reperfusion.The serum levels of CPK and LDH in UW group were significant lower than those in I/R group after 2 h of reperfusion,but no difference was observed between UW group and I/R group after 4 h and 6 h of reperfusion.After 4 h of ischemia,there were significant differences in water content,MDA,and SOD in skeletal muscle between UW group and I/R group,but no difference was found after 6 h of reperfusion.[Conclusion] Intraarterial washout with UW solution is effective in preserving skeletal muscle integrity against I/R insult.But this protective effect of UW solution should be improved.