丹参多酚酸盐预防小型猪DIEP皮瓣血管危象的实验研究

Salvianolate in treatment and prevention of vascular crisis after deep inferior epigastric perforator

目的观察丹参多酚酸盐对小型猪腹壁下血管穿支皮瓣(DIEP)血管危象的防治作用。方法制造双后肢皮肤软组织缺损的小型猪模型10头(共20例创面),按造模时间先后分为实验组和对照组。每组各5头小型猪共10例创面。所有小型猪均行腹壁下动脉外侧皮肤穿支皮瓣转移修复术,术后1h实验组予静脉滴注5%葡萄糖注射液250ml+丹参多酚酸盐60mg,对照组予静脉滴注5%葡萄糖注射液250ml;均为1次/d.疗程14d。比较两组小型猪术后24h(T_1)、3d(T_2)、7d(T_3)、14d(T_4)皮瓣皮肤血流灌注量和血液流变学指标;比较实验组术前24h(T_0)、术后24h(T_1)、3d(T_2)、7d(T_3)、14d(T_4)凝血四项即凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB);大体观察术后皮瓣血管危象的发生率;14d后计算两组小型猪皮瓣的存活面积比并进行统计学处理。结果 (1)血流灌注量实验组各时间点均大于对照组(均P<0.05),实验组T1明显大于术后前3d(P<0.01);(2)实验组T_3、T_4全血高、低切黏度、血浆黏度、RBC压积、RBC聚集指数明显低于对照组,RBC变形指数明显高于对照组(均P<0.05);(3)实验组各时间点凝血四项比较,均无统计学差异(均P>0.05);(4)实验组皮瓣血管危象发生率低于对照组(P<0.05);实验组皮瓣存活面积比明显高于对照组(P<0.01)。结论丹参多酚酸盐能增加小型猪DIEP皮肤血流灌注量,能降低血液黏稠度。抑制血小板聚集,改善血液流变学,抑制皮瓣血栓形成,降低血管危象的发生率,提高皮瓣存活面积,而对凝血四项无明显影响,安全性高。

Objective To investigate the effect of salvianolate in treating and preventing the vascular crisis after deep in- ferior epigastric perforator （DIEP） flap transplantation in miniature pigs. Methods Ten miniature pigs were used for bilateral hind legs skin and soft tissue defect model, and randomly assigned to study group and control group with 5 in each. The lateral inferior epigastric skin perforators vascular flap transfer repairing operation was performed on all pigs, and medication was given 1 h after surgery. 60mg sa/vianolate in 250 mt 5% glucose injection was intravenously dripped once a day for 14 days in study group, while same volume of 5% glucose was given to pigs in control group. The blood perfusion of skin flap and hemorrheology were com- pared at 24h（T,）, 3d（T2）, 7d（T3） and 14d after operation（T4） between two groups. The prothrombin time（PT）, international normal- ized ratio （INR）, activated partial thromboplastin time（APTT） and fibrinogen（FIB） levels were compared between two groups at dif- ferent time points. Meanwhile, the survival status of flaps was observed and compared between two groups. Results The blood perfusion in study group was higher than that of control group （P〈O.05）. The whole blood high and low viscosity, plasma viscosity, red blood cell （RBC） volume, RBC aggregation index were significantly decreased and RBC deformed index was increased in study group at T3, T4. There was no significant difference in blood coagulation indexes at all time points in study group （P 〉 0.05）. Compared to control group the incidence of vascular crisis was lower and the flap survival rate was higher in study group （P〈0.05 or 0.01）. Conclusion Salvianolate can increase the skin blood perfusion, lower plasma viscosity, inhibit body platelet ag- gregation, improve the hemorheology indexes and inhibit the formation of thrombosis, resulting in preventing vascular crisis and improve flap survival in DIEP flap transplantation.