地塞米松减轻皮瓣缺血——再灌注损伤所引起的全身损伤性反应

Effects of dexamethasone on systema after flap ischemia-reperfusion injury

目的:研究皮瓣缺血-再灌注损伤所引起的机体全身损伤性反应,阐明其机理及地塞米松的保护性作用。方法:将大鼠分为皮瓣原位缝合组(Ⅰ组),生理盐水对照组(Ⅱ组),地塞米松治疗组(Ⅲ组)。观察耳部微循环,肺、肠、耳部血管组织学改变。测量全血中性粒细胞凋亡率、死亡率,血浆TNFα,IL-10浓度.结果:Ⅰ组各项指标基本正常。Ⅱ组耳部微循环明显紊乱,肺、肠及耳部血管有明显组织学改变。中性粒细胞凋亡早期较少,坏死率较高。血浆TNFα于再灌注1h达到高峰,IL-10于再灌注3h达到最低。Ⅲ组耳部微循环明显改善,肺、肠及耳部血管组织学改变明显轻于Ⅱ组。中性粒细胞凋亡早期较多,坏死率较低。TNFα峰值明显低于对照组,6h即明显下降;IL-10再灌注1h达最低,3h就明显上升,其浓度明显高于对照组。结论:单纯形成皮瓣这一创伤对机体影响轻,缺血-再灌注损伤可造成肺、肠及耳部血管组织学改变,这与全身微循环紊乱;中性粒细胞凋亡与坏死过程失衡;分泌TNFα过高,IL-10过低有关。地塞米松早期应用可防治这种损伤,其作用机理是改善全身微循环,调理中性粒细胞的生命活动及平衡分泌细胞因子。

Objective To elucidate mechanisms of flap ischemia-reperfusion injury on systema and the protection of dexamethasone. Methods Rats were divided into sham,saline control and dexamethasone groups. Ear's microcirculation were observed,histological changes of lung,intestinal and ear vascular were studied.Apoptotic and necrosis of neutrophil were detected,plasma Tumor Necrosis Factor á(TNFá) and interleukin-10 (IL-10) were measured. Results It showed normal index in sham group. Dysfunctional ear's microcirculation;severe lung,intestinal and ear's vascular histological changes; imbalanced apoptotic and necrosis of neutrophil in blood;increased plasma TNFá,decreased IL-10 were in control group.Ameliorative ear's microcirculation; slight lung,intestinal and ear's vascular changes;normal neutrophil died process;lower TNFáand higher IL-10 level existed in dexamethasone group than that in control. Conclusion Simple flaps have no negative effect on systema,however,ischemia-reperfusion flap could demage lung, intestinal and ear's vascular,which correlate with dysfunctional microcirculation, imbalanced neutrophil died process and cytokines imbalance. Dexamethasone could protect systema from injury.