中性粒细胞在岛状肌皮瓣缺血再灌注损伤中的作用及NO干预

The Role of Neutrophils and Involvement of Nitric Oxide in Ischemia-Reperfusion Injury of Island Myocutaneous Flap

目的 :观察中性粒细胞 (NTR)在岛状肌皮瓣缺血再灌注 (I R)损伤过程中的作用及一氧化氮 (NO)对其的影响。方法 :采用猪腹直肌岛状肌皮瓣I R模型 ,于再灌注前后给予NO前体左旋精氨酸 (L arg) ,观察再灌注后不同时相皮瓣NTR渗出情况 ,并计算再灌注毕肌肉存活比例。结果 :(1)I R +L arg组再灌注 1h、4h皮瓣NTR计数明显低于I R组 ,差异有高度显著性 (P <0 .0 1)。 (2 )再灌注完毕 ,皮瓣肌肉存活比例 (83.70± 15 .6 0 ) %明显高于I R组 (2 4.0 7± 12 .35 ) % ,差异有高度显著性 (P <0 .0 1)。结论 :于缺血后再灌注前及再灌注早期给予L arg ,适当增加内皮源性NO的产生 。

Objective: To investigate the role of neutrophils and involvement of nitric oxide in ischemia reperfusion injury of island myocutaneous flaps. Methods: The epigastric myocutaneous island flaps models were set up. The flaps were divided into three groups:Control group(group A), ischemia reperfusion group that was treated with saline(group B), ischemia reperfusion group that was treated with L argnine(group C). In group B and group C, each flap was subjected to 6 hours of arteriovenous ischemia followed by 4 hours of perfusion. A bolus administration of L arginine(30 mg/kg) was given before the onset of reperfusion, followed by a continuous infusion of 10 mg/(kg·min)for 1 hour. Neutrophil counts, and muscle viability ratio in flap were determined. Results: Neutrophil counts after 1 and 4 hours of reperfusion were statistically decreased in group C as compared with group B (P<0.01). Flap measurements revealed that the average area of muscle survival was (83.70±15.60) percent in group C, which was significantly greater than the animals in group B, in which only (24.07±12.35) percent of the muscle was viable (P<0.01). Conclusion: These results show that administration of L arginine before and during the initial hour of reperfusion significantly improve myocutaneous flap survival.The mechanism of action seems to be related to nitric oxide mediated suppression of ischemia reperfusion injury through neutrophil activity inhibition.