Ciscato José G, Capellini Verena K, Celotto Andrea C, Baldo Caroline F, Joviliano Edwaldo E, Evora Paulo R B, Dalio Marcelo B, Piccinato Carlos E
Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
Scand J Trauma Resusc Emerg Med. 2010 Jul 19;18:41. doi: 10.1186/1757-7241-18-41.
The supraceliac aortic cross-clamping can be an option to save patients with hipovolemic shock due to abdominal trauma. However, this maneuver is associated with ischemia/reperfusion (I/R) injury strongly related to oxidative stress and reduction of nitric oxide bioavailability. Moreover, several studies demonstrated impairment in relaxation after I/R, but the time course of I/R necessary to induce vascular dysfunction is still controversial. We investigated whether 60 minutes of ischemia followed by 30 minutes of reperfusion do not change the relaxation of visceral arteries nor the plasma and renal levels of malondialdehyde (MDA) and nitrite plus nitrate (NOx).
Male mongrel dogs (n = 27) were randomly allocated in one of the three groups: sham (no clamping, n = 9), ischemia (supraceliac aortic cross-clamping for 60 minutes, n = 9), and I/R (60 minutes of ischemia followed by reperfusion for 30 minutes, n = 9). Relaxation of visceral arteries (celiac trunk, renal and superior mesenteric arteries) was studied in organ chambers. MDA and NOx concentrations were determined using a commercially available kit and an ozone-based chemiluminescence assay, respectively.
Both acetylcholine and calcium ionophore caused relaxation in endothelium-intact rings and no statistical differences were observed among the three groups. Sodium nitroprusside promoted relaxation in endothelium-denuded rings, and there were no inter-group statistical differences. Both plasma and renal concentrations of MDA and NOx showed no significant difference among the groups.
Supraceliac aortic cross-clamping for 60 minutes alone and followed by 30 minutes of reperfusion did not impair relaxation of canine visceral arteries nor evoke biochemical alterations in plasma or renal tissue.
对于因腹部创伤导致低血容量性休克的患者,腹主动脉上阻断术可能是一种挽救方法。然而,该操作与缺血/再灌注(I/R)损伤相关,而这种损伤与氧化应激及一氧化氮生物利用度降低密切相关。此外,多项研究表明I/R后舒张功能受损,但诱导血管功能障碍所需的I/R时间进程仍存在争议。我们研究了60分钟缺血后再灌注30分钟是否不会改变内脏动脉的舒张功能,以及血浆和肾脏中丙二醛(MDA)和亚硝酸盐加硝酸盐(NOx)的水平。
将雄性杂种犬(n = 27)随机分为三组之一:假手术组(未阻断,n = 9)、缺血组(腹主动脉上阻断60分钟,n = 9)和I/R组(缺血60分钟后再灌注30分钟,n = 9)。在内脏器官腔室中研究内脏动脉(腹腔干、肾动脉和肠系膜上动脉)的舒张功能。分别使用市售试剂盒和基于臭氧的化学发光分析法测定MDA和NOx浓度。
乙酰胆碱和钙离子载体均可使内皮完整的血管环舒张,三组之间未观察到统计学差异。硝普钠可使内皮剥脱的血管环舒张,组间无统计学差异。三组的血浆和肾脏中MDA和NOx浓度均无显著差异。
单独进行60分钟的腹主动脉上阻断并随后再灌注30分钟,并未损害犬内脏动脉的舒张功能,也未引起血浆或肾脏组织的生化改变。