Davis Scott L, Shibasaki Manabu, Low David A, Cui Jian, Keller David M, Wingo Jonathan E, Purdue Gary F, Hunt John L, Arnoldo Brett D, Kowalske Karen J, Crandall Craig G
Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75231, USA.
J Burn Care Res. 2009 Jul-Aug;30(4):675-85. doi: 10.1097/BCR.0b013e3181abfd43.
We previously identified impaired cutaneous vasodilation and sweating in grafted skin 5 to 9 months postsurgery. The aim of this investigation was to test the hypothesis that cutaneous vasodilation, but not sweating, is restored as the graft heals. Skin blood flow and sweat rate were assessed from grafted skin and adjacent noninjured skin in three groups of subjects: 5 to 9 months postsurgery (n=13), 2 to 3 years postsurgery (n=13), and 4 to 8 years postsurgery (n=13) during three separate protocols: 1) whole-body heating and cooling, 2) local administration of vasoactive drugs, and 3) local heating and cooling. Cutaneous vasodilation and sweating during whole-body heating were significantly lower (P<.001) in grafted skin when compared with noninjured skin across all groups and demonstrated no improvements with recovery time postsurgery. Maximal endothelial-dependent (acetylcholine) and endothelial-independent (sodium nitroprusside) cutaneous vasodilation remained attenuated (P<.001) in grafted skin up to 4 to 8 years postsurgery, indicating postsynaptic impairments. In grafted skin, cutaneous vasoconstriction during whole-body and local cooling was preserved, whereas vasodilation to local heating was impaired, regardless of the duration postsurgery. Split-thickness skin grafts have impaired cutaneous vasodilation and sweating up to 4 to 8 years postsurgery, thereby limiting the capability of this skin's contribution to thermoregulation during a heats stress. In contrast, grafted skin has preserved vasoconstrictor capacity.
我们之前发现，术后5至9个月移植皮肤的皮肤血管舒张和出汗功能受损。本研究的目的是验证以下假设：随着移植皮肤愈合，皮肤血管舒张功能会恢复，但出汗功能不会恢复。在三组受试者的移植皮肤和相邻未受伤皮肤中评估皮肤血流量和出汗率，这三组受试者分别为：术后5至9个月（n = 13）、术后2至3年（n = 13）、术后4至8年（n = 13），评估过程分三个独立方案进行：1）全身加热和冷却；2）局部给予血管活性药物；3）局部加热和冷却。在所有组中，与未受伤皮肤相比，移植皮肤在全身加热期间的皮肤血管舒张和出汗明显更低（P <.001），并且未显示出随着术后恢复时间而改善。直至术后4至8年，移植皮肤中最大内皮依赖性（乙酰胆碱）和内皮非依赖性（硝普钠）皮肤血管舒张仍减弱（P <.001），表明存在突触后损伤。在移植皮肤中，无论术后时长如何，全身和局部冷却期间的皮肤血管收缩得以保留，而对局部加热的血管舒张受损。直至术后4至8年，断层皮片移植的皮肤血管舒张和出汗功能受损，从而限制了该皮肤在热应激期间对体温调节的贡献能力。相比之下，移植皮肤保留了血管收缩能力。
