摘要
目的:探讨肌瓣超长时间热缺血后,再灌注期微静脉的形态学和组织学变化,及其对微循环和组织细胞的影响,以期了解超长时间缺血肌肉组织严重损伤的原因。方法:以体质量180～220g雄性SD大鼠,制成大鼠提睾肌缺血-再灌注模型(热缺血5h,再灌注2h),观察缺血-再灌注期肌瓣微循环形态学和组织学的变化。结果:①缺血5h后,微动脉于再灌注期出现明显痉挛并伴随血流速度的减缓;而伴行的微静脉扩张,流速明显变缓,局部形成附壁血栓,部分微静脉出现原发或继发性无复流现象,局部微静脉回流障碍。②组织学检查提示,再灌注期微静脉内壁可见大量的中性粒细胞黏附,而动脉内未见明显的附壁白细胞;局部可见附壁血栓,血管周围组织内可见游出的中性粒细胞;透射电镜检查也提示血管内皮细胞明显受损伤。③再灌注期微静脉回流障碍,局部形成一种“只灌不流”的病理现象,出现继发性静脉缺血,使肌瓣组织出现大片明显的漏出性出血,加重组织细胞的损伤。结论:再灌注期微静脉继发性缺血和随即形成的漏出性出血可能是肌肉组织超长时间缺血后严重损伤的重要因素。
AIM:To investigate the histological and morphological changes of venule and its effects on the microcirculation and tissue cells following prolonged ischemia,so as to expose the cause of serious injury of muscle following prolonged ischemia. METHODS:Male SD rats weighing 180 to 220 g were ased to make rat models of ischemic reperfusion cremaster muscles, subjected to 5 hours of warm ischemia and 2 hours of reperfusion,and then the morphological and histological changes of microcirculation of ischemia and reperfusion cremaster muscles were observed. RESULTS:①The obvious vasospasm was observed during the reperfusion of arteriole and decelerated with velocity of blood, whereas the parallel venule dilated significantly and its blood velocity also decreased markedly, moreover intravascular thrombosis was formed locally and the primary and secondary no reflow of dilating venule were found.② It was suggested that a large number of neutrophil adhering to the vessel wall of venule were observed during the reperfusion, however, no adhering leucocytes were found in arteriole. Mural thrombus and neutrophil were observed in the local space and in the blood vessel circumference tissues respectively.Also endothelial cell damage was showed with transmission electron microscopy.③The pathological phenomena of “only irrigation and no reflow”was observed in local muscle flap by reflu of microvenule reperfusion, which finally resulted in secondary venosum ischemia, the large scale leakage hemorrhage and aggravated the injure of histocyte. CONCLUSION:Secondary venosum ischemia and large scale leakage hemorrhage are the key factors of injury of muscle following prolonged ischemia.
出处
《中国临床康复》
CSCD
2004年第26期5590-5591,i005,共3页
Chinese Journal of Clinical Rehabilitation
