Turóczi Zsolt, Fülöp András, Lukáts Akos, Garbaisz Dávid, Lotz Gábor, Harsányi László, Szijártó Attila
11st Department of Surgery, Semmelweis University, Budapest, Hungary.
J Invest Surg. 2014 Oct;27(5):282-90. doi: 10.3109/08941939.2014.916367. Epub 2014 May 15.
PURPOSE/AIM OF THE STUDY: Long-lasting lower limb arterial occlusion is a condition with high incidence and complication rates. With the absence of appropriate treatment to cure advanced complications, mortality rates are high. Postconditioning (PC) might be capable of limiting the degree of ischemic-reperfusion (IR) injuries, thus reducing complications and mortality rates. The aim of this study was to evaluate the impact of postconditioning during the first postoperative day on skeletal muscle after a long-lasting arterial occlusion.
Male Wistar rats (n = 72) underwent 8 hr of infrarenal aortic occlusion followed by 2, 6, 12, or 24 hr of reperfusion. In one group of each reperfusion period, postconditioning was applied. Muscle samples were collected for histological examinations. Furthermore, muscle fiber viability and muscle wet-to-dry ratio were assessed. Blood samples were taken for creatine-kinase measurements.
Postconditioning strongly reduced morphological injury compared to the corresponding ischemic-reperfusion group (p < .001). Serum creatine-kinase levels showed a peak at 6 hr post-ischemia (IR: 6702.2 ± 797.5; PC: 5523.3 ± 769.3 IU/l) and decreased to normal level by the end of the experiment (Sham: 171.5 ± 71.6; IR: 186.2 ± 82.7; PC: 174.2 ± 72.4 IU/l). Creatine-kinase levels were significantly reduced by postconditioning (p2hr = .028; p6hr = .06; p12hr = .042). A marked decrease in viability was observed in the ischemic-reperfusion groups (2 hr: 11.0 ± 4.1; 6 hr: 10.3 ± 3.6; 12 hr: 9.4 ± 3.3; 24 hr: 8.6 ± 2.8%), whereas with postconditioning, viability was preserved (2 hr: 26.4 ± 5.5; 6 hr: 24.6 ± 4.5; 12 hr: 24.5 ± 6.8; 24 hr: 26.2 ± 6.1%; p < .001); moreover, a significant decrease in the wet-to-dry ratio was achieved (p < .001).
Postconditioning was able to reduce local complications after a long-lasting lower limb vascular occlusion.
持久性下肢动脉闭塞是一种发病率和并发症发生率都很高的病症。由于缺乏治愈晚期并发症的适当治疗方法，死亡率很高。缺血后处理（PC）可能能够限制缺血再灌注（IR）损伤的程度，从而降低并发症和死亡率。本研究的目的是评估术后第一天进行缺血后处理对持久性动脉闭塞后骨骼肌的影响。
雄性Wistar大鼠（n = 72）接受8小时肾下腹主动脉闭塞，然后再灌注2、6、12或24小时。在每个再灌注时间段的一组大鼠中应用缺血后处理。采集肌肉样本进行组织学检查。此外，评估肌纤维活力和肌肉湿干比。采集血样测量肌酸激酶。
与相应的缺血再灌注组相比，缺血后处理显著减少了形态学损伤（p < .001）。血清肌酸激酶水平在缺血后6小时达到峰值（IR：6702.2±797.5；PC：5523.3±769.3 IU/l），并在实验结束时降至正常水平（假手术组：171.5±71.6；IR：186.2±82.7；PC：174.2±72.4 IU/l）。缺血后处理显著降低了肌酸激酶水平（p2小时 = .028；p6小时 = .06；p12小时 = .042）。在缺血再灌注组中观察到活力显著下降（2小时：11.0±4.1；6小时：10.3±3.6；12小时：9.4±3.3；24小时：8.6±2.8%），而通过缺血后处理，活力得以保留（2小时：26.4±5.5；6小时：24.6±4.5；12小时：24.5±6.8；24小时：26.2±6.1%；p < .001）；此外，湿干比显著降低（p < .001）。
缺血后处理能够减少持久性下肢血管闭塞后的局部并发症。
