Fowler J D, Li X, Cooley B C
Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada.
Microsurgery. 1999;19(3):135-40. doi: 10.1002/(sici)1098-2752(1999)19:3<135::aid-micr3>3.0.co;2-y.
This study investigated the use of heparinized and/or citrated whole blood as a perfusate for enhancing muscle tolerance to warm ischemia. Unilateral cutaneous trunci muscle flaps were harvested from Sprague-Dawley rats and stored for 10 hr at 22-24 degrees C prior to transplantation to the groin. One group served as a non-perfused control. In three experimental groups, the flaps were hand-perfused ex vivo with 1.0 ml of heparinized, citrated, or heparinized and citrated autogenous whole blood at physiological pressures. Perfusion was administered over a 10-min period 5 hr into the ischemic period. Flaps were revascularized on the femoral vessels and then harvested 48 hr following revascularization. Tissue injury was assessed by calculation of flap weight change (indicator of tissue edema), histochemical evaluation of muscle dehydrogenase activity (nitroblue tetrazolium assay), and light microscopy. All perfused groups had significantly higher muscle dehydrogenase activity compared with non-perfused controls (P < 0.005). Perfusion with combined heparin-citrated blood was significantly more protective than perfusion with either anticoagulant alone (P < 0.025). The only statistically significant reduction in percent flap edema was seen in the combined heparin-citrate perfusion of flaps compared with nonperfused controls (P < 0.05). Histologic evaluation confirmed a reduction in tissue edema in the perfused flaps. We conclude that mid-ischemic perfusion with heparinized and/or citrated blood limits the deleterious effects of extended warm ischemia.
本研究调查了使用肝素化和/或枸橼酸化全血作为灌注液以增强肌肉对热缺血的耐受性。从Sprague-Dawley大鼠身上切取单侧躯干皮肤肌瓣，在移植到腹股沟前于22 - 24摄氏度下保存10小时。一组作为未灌注对照组。在三个实验组中，肌瓣在生理压力下用1.0毫升肝素化、枸橼酸化或肝素化且枸橼酸化的自体全血进行体外手工灌注。在缺血期5小时时进行为期10分钟的灌注。肌瓣在股血管上进行血管重建，然后在血管重建后48小时取材。通过计算肌瓣重量变化（组织水肿指标）、肌肉脱氢酶活性的组织化学评估（硝基蓝四氮唑试验）和光学显微镜检查来评估组织损伤。与未灌注对照组相比，所有灌注组的肌肉脱氢酶活性均显著更高（P < 0.005）。联合使用肝素 - 枸橼酸化血液灌注比单独使用任何一种抗凝剂灌注具有更显著的保护作用（P < 0.025）。与未灌注对照组相比，仅在联合肝素 - 枸橼酸盐灌注的肌瓣中观察到肌瓣水肿百分比有统计学意义的降低（P < 0.05）。组织学评估证实灌注后的肌瓣组织水肿减轻。我们得出结论，在缺血中期用肝素化和/或枸橼酸化血液灌注可限制延长的热缺血的有害影响。
