Chachques J C, Fabiani J N, Acar C, Jebara V A, Dreyfus G, Mosnier M, Carpentier A
Département de Chirurgie Cardio-Vasculaire, Hôpital Broussais, Paris.
J Mal Vasc. 1988;13(2):95-100.
Evaluation of degree of muscle ischemia of a limb and its reversibility is a poorly resolved practical problem, and it has not been clarified whether vasodilatory and circulatory spasmolytic substances possess, in addition to an effect of increasing irrigation, any direct action on muscle cell energy metabolism. An experimental study used histochemical techniques to evaluate oxidative enzyme activity of tissues. The compound tetrazolium nitro-blue (NBT), when reduced by tissue dehydrogenases, has the property of producing a dense non-crystalline blue pigment designated "formazan". During muscle ischemia, the time of appearance of this reaction increases with degree of ischemia through the bias of the decrease or disappearance of succinate-dehydrogenases. Transient ischemia of hindpaw, over 3, 6, 9, 12, 15 and 18 hours, was provoked by tourniquet in 49 rats treated with a vasodilator (naftidrofuryl) and 21 untreated (control) rats. Spontaneous revascularization occurred after removal of the tourniquet. Muscles were studied by microsurgical removal of specimens on removal of tourniquet and 1 and 12 hours and 3, 7 and 14 days after its removal (fig. 1 and 2). Times for staining of muscles with tetrazolium were measured and curves of comparative times established (fig. 3 and 4). Histopathologic specimens were also obtained at the same periods (fig. 5, 6, 7). Results of histochemical studies with tetrazolium and with quantitative determination of degree of cellular anoxia showed the action of naftidrofuryl to be related to mitochondrial metabolism of skeletal muscle, specifically for succinate-dehydrogenase. Clinical application in the determination of therapy and of functional prognosis of an ischemic limb is a possibility by the use of the NBT test in vascular surgery.
评估肢体肌肉缺血程度及其可逆性是一个尚未得到很好解决的实际问题，而且血管舒张和循环解痉物质除了具有增加灌注的作用外，是否对肌肉细胞能量代谢有任何直接作用也尚未明确。一项实验研究使用组织化学技术评估组织的氧化酶活性。化合物硝基蓝四氮唑（NBT）在被组织脱氢酶还原时，具有产生一种致密的非结晶蓝色色素“甲臜”的特性。在肌肉缺血期间，通过琥珀酸脱氢酶的减少或消失，这种反应出现的时间随着缺血程度的增加而延长。在49只接受血管扩张剂（萘呋胺酯）治疗的大鼠和21只未治疗的（对照）大鼠中，通过止血带造成后肢3、6、9、12、15和18小时的短暂缺血。去除止血带后会发生自发再血管化。在去除止血带时、去除后1小时和12小时以及3、7和14天，通过显微手术切除标本对肌肉进行研究（图1和图2）。测量肌肉用四氮唑染色的时间并建立比较时间曲线（图3和图4）。在同一时期也获取了组织病理学标本（图5、6、7）。用四氮唑进行的组织化学研究结果以及细胞缺氧程度的定量测定表明，萘呋胺酯的作用与骨骼肌的线粒体代谢有关，特别是对于琥珀酸脱氢酶。在血管外科手术中使用NBT试验，有可能在确定缺血肢体的治疗和功能预后方面得到临床应用。
