摘要
缺血再灌注伤的预防方法已有较多研究，但用局部降温方法者则少见报道。将１６只日本大耳兔随机分成四组。每组一侧后肢降温后上止血带为实验组，另一侧后肢不降温上止血带作对照组。甲乙两组缺血４ｈ，分别再灌注１和２ｈ；丙丁两组缺血５ｈ，再分别灌注１和２ｈ。用针极温度传感器测得降温后深部肌温平均为１６．６℃。去除止血带再灌注后，取双侧股静脉血作钾、乳酸、超氧化物歧化酶及脂质过氧化物检测，并取腓肠肌作光镜和电镜组织学检查。结果发现，降温组血钾、乳酸及脂质过氧化物均低于对照组，经统计学处理有显著差异（Ｐ＜０．０１）；超氧化物岐化酶高于对照侧，有显著差异（Ｐ＜０．０１）。光镜及电镜亦发现降温组横纹肌结构损害较轻，属可逆性损害范围，肌细胞有再生可能。临床应用４５例。四肢手术前将深部肌温降到２２．４℃左右，使用止血带时间平均２ｈ５７ｍｉｎ，最长达４ｈ３１ｍｉｎ，其中９例术后指尖出现一过性麻木，未发现皮肤、肌肉及神经损害。证实，局部降温确有预防或减轻再灌注伤的作用。
Local hypothermia as a preventive method to reperfusion injury of skeletal muscles was studied. Sixteen Japanese rabbits were divided into four groups at random. Before the tourniquet was inflated, a cold gel pack was applied to the right hind leg of each rabbit for 15 minutes to produce local hypothermic condition, without application of tourniquet the left hind limb was under local hypothermic condition as a control. The duration of tourniquet ischemia was 4 hours, and then reperfusion for one and two hours in the A and B groups respectively; in the C and D groups the duration of ischemia was 5 hours, and reperfusion for one and two hours, respectively. The muscle temperature averaged 16.6℃ with a needle thermocouple in the hind limb under local hypothermia. The serum K +, LA, SOD, LPO were determined from bilateral femoral veins, and electron and light microscopic studies of sural muscles were done in the post reperfusion period. It was found that the K +, LA, LPO were lower than that of the control groups (P< 0.01 ), but SOD was higher than that of the control group (P<0.01). Electron and light microscopic studies showed sight but reversible damage of muscular structure with the possibility of in the hypothermic groups cell regeneretion. Basing on this experimental results, this method was applied in 45 cases reparative and reconstructive surgery of limbs. The duration of application of tourniquet averaged 2 hours and 57 minutes, the longest being 4 hours and 31 minutes, when the muscle temperature had reduced to 22.4℃. There were no postoperative complications associated with this technique. Local hypothermia appeared to be a safe and effective method of decreasing the reperfusion damage after ischemia.
出处
《中国修复重建外科杂志》
CAS
CSCD
1997年第1期52-55,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
降温
缺血再灌注伤
骨骼肌
Hypothermia Post ischemia reperfusion damage Experimental study Clinical application
