腹主动脉阻断时局部和远程缺血预处理的微循环效应。

Microcirculatory effects of local and remote ischemic preconditioning in supraceliac aortic clamping.

机构信息

Department of Surgery, Federal University of São Paulo, São Paulo, SP, Brazil.

出版信息

J Vasc Surg. 2010 Nov;52(5):1321-9. doi: 10.1016/j.jvs.2010.05.120. Epub 2010 Jul 31.

DOI:10.1016/j.jvs.2010.05.120

PMID:20674244

Abstract

INTRODUCTION

Supraceliac aortic clamping in major vascular procedures promotes splanchnic ischemia and reperfusion (I/R) injury that may induce endothelial dysfunction, widespread inflammation, multiorgan dysfunction, and death. We tested the hypothesis that local or remote ischemic preconditioning (IPC) may be protective against injury after supraceliac aortic clamping through the modulation of mesenteric leukocyte-endothelial interactions, as evaluated with intravital microscopy and expression of adhesion molecules.

METHODS

Fifty-six male Wistar rats (weight, 190 to 250 g), were divided into four groups of 14 rats each: control-sham surgery without aortic occlusion; I/R through supraceliac aortic occlusion for 20 minutes, followed by 120 minutes of reperfusion; local IPC through supraceliac aortic occlusion for two cycles of 5 minutes of ischemia and 5 minutes of reperfusion, followed by the same protocol of the IR group; remote IPC through infrarenal aortic occlusion for two cycles of 10 minutes of ischemia and 10 minutes of reperfusion, followed by the same protocol of the IR group. Seven animals per group were used to evaluate in vivo leukocyte-endothelial interactions in postcapillary venules with intravital microscopy and another seven animals per group were used to collect mesentery samples for immunohistochemistry demonstration of adhesion molecules expression.

RESULTS

Supraceliac aortic occlusion increased the number of rolling leukocytes with slower velocities and increased the number of adherent leukocytes to the venular surface and leukocyte migration to the interstitium. The expression of P-selectin, E-selectin, and intercellular adhesion molecule-1 was also increased significantly after I/R. Local or remote IPC reduced the leukocyte recruitment in vivo and normalized the expression of adhesion molecules.

CONCLUSIONS

Local or remote IPC reduces endothelial dysfunction on mesenteric microcirculation caused by I/R injury after supraceliac aortic clamping.

摘要

简介

在大型血管手术中，对主动脉进行 supra 膈夹闭会导致内脏缺血再灌注（I/R）损伤，从而可能引发内皮功能障碍、广泛炎症、多器官功能障碍和死亡。我们通过活体显微镜检查和黏附分子表达来评估肠系膜白细胞-内皮相互作用，验证了局部或远程缺血预处理（IPC）可能通过调节肠系膜白细胞-内皮相互作用，对 supra 膈主动脉夹闭后的损伤起到保护作用的假设。

方法

将 56 只雄性 Wistar 大鼠（体重 190 至 250g）分为 4 组，每组 14 只：无主动脉闭塞的对照假手术组；supra 膈主动脉夹闭 20 分钟，再灌注 120 分钟的 I/R 组；supra 膈主动脉夹闭 2 个 5 分钟缺血-5 分钟再灌注周期的局部 IPC 组，随后进行 I/R 组的相同方案；通过 infra 肾主动脉夹闭 2 个 10 分钟缺血-10 分钟再灌注周期的远程 IPC 组，随后进行 I/R 组的相同方案。每组 7 只动物用于通过活体显微镜检查评估后微静脉中的白细胞-内皮相互作用，每组另外 7 只动物用于收集肠系膜样本，以进行黏附分子表达的免疫组化示踪。