Wadström J
Department of Surgery, University Hospital, Uppsala, Sweden.
Scand J Plast Reconstr Surg Hand Surg Suppl. 1990;21:1-42.
An experimental model was developed for investigations of traumatically induced vasospasm (TVS) in the central ear artery (CEA) of the awake rabbit. Spasm was induced by a 3-second long pinch with a clip applying forceps exerting a standardized compression force between its claws. The vessel was transilluminated with cold light and inspected from above with an operating microscope equipped with a video camera. The internal diameter was continuously measured. TVS was assessed in terms of its duration, intensity (reduction of initial diameter) and severity (integrated change in diameter over time). The spasm lasted about 10-20 minutes and the inner diameter decreased to about 15-20% of the pretrauma values. The preparation was stable for at least 3 hours and repetitive pinches in different segments of the vessel caused reproducible spasms. TVS was more pronounced when the duration of trauma was prolonged and weakened when the same vessel segment was traumatized repeatedly. The nervous influence was studied after partial denervation of the ear, after partial denervation with additional nervous blockade, and after total denervation achieved by amputation and replantation of the ear. It was found that denervation had no influence on the TVS. Ice cooling was used to decrease the body temperature by 1.0 degree and 1.75 degree C. This caused a significant increase in duration and severity, but not in intensity of TVS. Bleeding by 20% of the total blood volume or hypervolaemic haemodilution with dextran infusion, 20% of total blood volume, did not affect the spasm. Blood flow of CEA was totally obstructed by ligation of the side branches along a 7 cm long segment and subsequent ligation of CEA distal to the segment. This resulted in decreased duration and severity of TVS. Topical application of 2 or 20% lidocaine or of 3% pentobarbital one minute after vessel trauma, when the vessel was maximally constricted, caused prompt resolution of the TVS. The rapid resolution was followed by drug-induced vasoconstriction to about 60% of the initial pre-spasm values. During this vasoconstriction the vessels were refractory to trauma. The results strongly suggest that TVS is a locally elicited phenomenon of vascular smooth muscle, and can be influenced by local application of lidocaine or pentobarbital.
建立了一个实验模型,用于研究清醒家兔中耳动脉(CEA)创伤性血管痉挛(TVS)。通过用夹钳进行3秒的挤压来诱导痉挛,夹钳在其爪之间施加标准化的压缩力。用冷光对血管进行透照,并通过配备摄像机的手术显微镜从上方进行观察。连续测量内径。从持续时间、强度(初始直径的减小)和严重程度(直径随时间的综合变化)方面评估TVS。痉挛持续约10 - 20分钟,内径减小至创伤前值的约15 - 20%。该标本至少稳定3小时,在血管的不同节段重复挤压可引起可重复的痉挛。当创伤持续时间延长时,TVS更明显;当同一血管节段反复受到创伤时,TVS则减弱。在部分去神经支配耳部后、部分去神经支配并附加神经阻滞之后以及通过耳部截肢和再植实现完全去神经支配之后,研究了神经的影响。发现去神经支配对TVS没有影响。使用冰敷将体温降低1.0摄氏度和1.75摄氏度。这导致TVS的持续时间和严重程度显著增加,但强度未增加。放血占总血容量的20%或用右旋糖酐输注进行高血容量血液稀释(占总血容量的20%),均不影响痉挛。通过结扎7厘米长节段的侧支,随后结扎该节段远端的CEA,完全阻断了CEA的血流。这导致TVS的持续时间和严重程度降低。在血管创伤1分钟后,当血管最大程度收缩时,局部应用2%或20%的利多卡因或3%的戊巴比妥,可使TVS迅速缓解。迅速缓解之后,药物诱导血管收缩至痉挛前初始值的约60%。在这种血管收缩过程中,血管对创伤无反应。结果强烈表明,TVS是血管平滑肌局部引发的现象,可受到局部应用利多卡因或戊巴比妥的影响。