Thomson I A, Egginton S, Hudlická O, Sims M H
Department of Physiology, University of Birmingham Medical School, U.K.
Eur J Vasc Surg. 1994 May;8(3):335-41. doi: 10.1016/s0950-821x(05)80152-5.
Intraarterial bolus treatment with the prostacyclin analogue iloprost appears to have a prolonged beneficial effect on femorodistal bypass graft flow which extends beyond the duration of its vasodilator properties. The effect of iloprost on the microcirculation rendered ischaemic over the time course of a distal bypass operation was investigated in this study without the use of fluorescent light.
A rat model was designed to allow prolonged direct observation of leukocyte-venular endothelial adhesion in a femorodistal bypass simulation. The extensor digitorum longus (EDL) muscle of 10 rats was subjected to two 30 minute periods of ischaemia by a non-venous occluding tourniquet and to simulate some of the changes of chronic ischaemia the adverse effect of ischaemia was accentuated by indirect electrical stimulation via the lateral popliteal nerve.
Intraarterial bolus treatment with iloprost significantly reduced the total numbers of leukocytes observed in EDL venules, and the numbers exhibiting evidence of adhesion by rolling or sticking to venule endothelium compared with saline controls at one hour post ischaemia. Ischaemia induced vasodilatation and reduced shear stress by a similar and significant amount in both groups.
Two periods of ischaemia and reperfusion similar to those which occur during bypass grafting resulted in changes in the distal microcirculation consistent with reperfusion injury. Intraarterial bolus treatment with iloprost prevented these leucocyte-endothelial changes. It appears iloprost may have a role in reducing leukocyte-induced reperfusion injury in femorodistal bypass surgery.
前列环素类似物伊洛前列素的动脉内推注治疗似乎对股-远端旁路移植血流具有延长的有益作用，该作用超出其血管扩张特性的持续时间。本研究在不使用荧光灯的情况下，研究了伊洛前列素对在远端旁路手术过程中出现缺血的微循环的影响。
设计了一种大鼠模型，以便在股-远端旁路模拟中长时间直接观察白细胞-小静脉内皮粘附情况。对10只大鼠的趾长伸肌（EDL）通过非静脉阻塞性止血带进行两个30分钟的缺血期，并通过外侧腘神经间接电刺激加重缺血的不良影响，以模拟慢性缺血的一些变化。
与生理盐水对照组相比，伊洛前列素动脉内推注治疗在缺血后1小时显著减少了在EDL小静脉中观察到的白细胞总数，以及表现出通过滚动或粘附于小静脉内皮而发生粘附迹象的白细胞数量。两组中缺血诱导的血管扩张和剪切应力降低程度相似且显著。
与旁路移植过程中发生的缺血和再灌注相似的两个时期，导致远端微循环发生与再灌注损伤一致的变化。伊洛前列素动脉内推注治疗可防止这些白细胞-内皮变化。伊洛前列素似乎可能在减少股-远端旁路手术中白细胞诱导的再灌注损伤方面发挥作用。
