Belkin M, Valeri C R, Hobson R W
Department of Surgery, Boston University School of Medicine, MA.
J Vasc Surg. 1989 Jan;9(1):161-8.
Administration of intraarterial fibrinolytic agents has been recommended after balloon catheter thrombectomy to reduce retained thrombus and to improve the patency of collateral vasculature. However, the potential for improvement in the viability of skeletal muscle after ischemia as a result of this therapy has not been evaluated. We investigated the effect of intraarterial urokinase (UK) on the salvage of ischemic skeletal muscle in a bilateral, in vivo, isolated gracilis muscle model. In six anesthetized dogs each gracilis muscle was subjected to 5 hours of ischemia by temporary occlusion of the gracilis artery. Before reperfusion, the experimental muscle received an intraarterial infusion of UK (30,000 units) whereas the control muscle received saline solution. Each muscle was then reperfused for 90 minutes. Triphenyltetrazolium chloride staining demonstrated infarction of 20.2% +/- 8.1% in control muscles compared with 8.6% +/- 6.2% in UK-infused muscles (p less than 0.01). Control muscles gained significantly more weight from edema (33.6 +/- 5.9 gm) than UK-infused muscles (18.2 +/- 4.1 gm; p less than 0.05). Coagulation studies confirmed that an isolated fibrinolytic effect occurred on the experimental side. These studies suggest that intraarterial UK may be a useful adjunctive therapy after revascularization of the acutely ischemic limb and that further clinical trials are recommended.
在球囊导管血栓切除术之后，推荐使用动脉内纤维蛋白溶解剂，以减少残留血栓并改善侧支血管的通畅性。然而，尚未评估这种治疗对缺血后骨骼肌活力改善的可能性。我们在双侧体内分离股薄肌模型中研究了动脉内尿激酶（UK）对缺血骨骼肌挽救的作用。在六只麻醉的狗中，通过暂时阻断股薄肌动脉使每只股薄肌遭受5小时的缺血。在再灌注前，实验肌肉接受动脉内输注UK（30,000单位），而对照肌肉接受盐溶液。然后每块肌肉再灌注90分钟。氯化三苯基四氮唑染色显示对照肌肉梗死率为20.2%±8.1%，而输注UK的肌肉梗死率为8.6%±6.2%（p<0.01）。对照肌肉因水肿增加的重量（33.6±5.9克）明显多于输注UK的肌肉（18.2±4.1克；p<0.05）。凝血研究证实实验侧发生了孤立的纤维蛋白溶解作用。这些研究表明，动脉内UK可能是急性缺血肢体血管重建术后一种有用的辅助治疗方法，建议进一步进行临床试验。
