Blebea J, Cambria R A, DeFouw D, Feinberg R N, Hobson R W, Duran W N
Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark.
J Vasc Surg. 1990 Dec;12(6):657-65; discussion 665-6. doi: 10.1067/mva.1990.25129.
Increased vascular permeability is an early and sensitive indicator of ischemic muscle injury, occurring before significant histologic or radionuclide changes are evident. We investigated the effect of iloprost, a stable prostacyclin analog, on microvascular permeability in a rat striated muscle model. In six control and six experimental animals the cremaster muscle was dissected, placed in a closed-flow acrylic chamber, and suffused with a bicarbonate buffer solution. Dextran labeled with fluorescein was injected intravenously as a macromolecular tracer, and microvascular permeability was determined on the basis of clearance of the fluorescent tracer. Two hours of ischemia were followed by 2 hours of reperfusion. In the experimental group iloprost (0.5 microgram/kg/min) was given in a continuous intravenous infusion. Microvascular permeability increased significantly during reperfusion in both control and experimental animals (p less than 0.0001). Treatment with iloprost, however, significantly attenuated this response compared to the control group, 4.8 +/- 0.3 versus 7.3 +/- 0.5 microliters/gm/min, respectively (p less than 0.0001). Iloprost decreases the rise in vascular permeability after ischemia and reperfusion. Experimental clinical use of iloprost under controlled conditions in the treatment of patients with acute skeletal muscle ischemia appears justified.
血管通透性增加是缺血性肌肉损伤的早期敏感指标，在明显的组织学或放射性核素变化出现之前就已发生。我们在大鼠横纹肌模型中研究了稳定的前列环素类似物伊洛前列素对微血管通透性的影响。在6只对照动物和6只实验动物中，解剖提睾肌，置于封闭流动的丙烯酸腔室中，并用碳酸氢盐缓冲溶液灌注。静脉注射用荧光素标记的右旋糖酐作为大分子示踪剂，并根据荧光示踪剂的清除率测定微血管通透性。缺血2小时后再灌注2小时。在实验组中，以0.5微克/千克/分钟的速度持续静脉输注伊洛前列素。在对照动物和实验动物的再灌注过程中，微血管通透性均显著增加（p<0.0001）。然而，与对照组相比，伊洛前列素治疗显著减弱了这种反应，分别为4.8±0.3与7.3±0.5微升/克/分钟（p<0.0001）。伊洛前列素可降低缺血再灌注后血管通透性的升高。在可控条件下对急性骨骼肌缺血患者进行伊洛前列素的实验性临床应用似乎是合理的。
