重组水蛭素对大鼠撕脱皮瓣存活的影响

Influence of recombinant hirudin on survival of rat dorsal avulsed flap

目的 探讨重组水蛭素对撕脱皮瓣的保护作用及其在临床治疗撕脱皮瓣的应用前景.方法 将108只SD大鼠随机分为重组水蛭素组（A组）、低分子肝素组（B组）、生理盐水组（C组,对照组）,并形成撕脱皮瓣后原位缝合.术后即刻、12 h、24 h、48 h,给予皮瓣蒂部、距蒂部2 cm和4 cm3等分点皮下注射重组水蛭素、低分子肝素、生理盐水,于术后12 h、1d、3d、5d、7d,分别检测皮瓣远端组织内P选择素和血管内皮细胞生长因子（VEGF）含量,病理切片观察皮瓣远端组织毛细血管内炎性细胞聚集及微血栓形成情况,术后14d计算皮瓣存活率.结果 A组P选择素含量比B组、C组增加不明显,差异具有统计学意义（P＜0.05）,A组VEGF含量比B组、C组明显增加,差异具有统计学意义（P＜0.05）;术后14 d皮瓣存活率A组明显高于B组（P＜0.05）和C组（P＜0.01）,差异具有统计学意义.结论 局部注射重组水蛭素能有效抑制P选择素的生成,减少炎性细胞的聚集,阻断微血栓的形成,改善撕脱皮瓣的局部缺血、缺氧状态;减弱内皮细胞的损伤,促进VEGF的表达,刺激新生毛细血管增生,提高撕脱皮瓣的存活率.

Objective To investigate the protective effect and mechanism of recombinant hirudin on avulsed flap and to explore the application of recombinant hirudin in clinical treating avulsed flap.Methods 108 Sprague-Dawley rats were randomly divided into three groups：local injecting recombinant hirudin （group A）,local injecting low molecular heparin （group B）,and local injecting physiological saline （group C）.The far ends were sutured after forming dorsal avulsed flap with local freeing.The levels of P-selectin and VEGF were detected,and the inflammatory cell aggregation and formation of microthrombus were observed in pathological section.On 14th postsurgery day the survival rate of flap was calculated.Results The content of P-selectin in group A was lower than that of groups B and C,with a statistical difference （P〈0.05）.The content of VEFG in group A was higher than that of groups B and C,with a statistical difference （P〈0.05）.On 14th postsurgery day,group A was higher than that in groups B （P〈0.05）and C （P〈0.01） in the survival rate of flap.Conclusions Locally injected recombinant hirudin can actively suppress the production of P-selectin,reduce accumulation of inflammatory cells,prevent information of microthrombus,improve ischemia and anoxia of avulsed flaps,decrease injuries of endotheliocyte,enhance the expression of VEGF,and stimulate hyperplasia of neogenesis capillaries that elevate survival rate of avulsed flaps.