Urbaniak J R, Seaber A V, Chen L E
Orthopedic Research Laboratories, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Clin Orthop Relat Res. 1997 Jan(334):30-6.
Direct videomicroscopy of the rat cremaster muscle microcirculation supplemented by animal models of replantation, vascular crushing, and muscle function after injury and recovery were used to investigate the occurrence of reperfusion failure. It is evident that failure of blood reflow may be induced by multiple factors that can be grouped into categories of ischemia, intimal damage, and systemic or local responses, which are referred to as the no reflow triad. The components comprising the 3 sides of the no reflow triad can interact with one another in an intricate manner, and any single factor or combination of factors is capable of triggering the events leading to reperfusion failure. The pronounced regional nature of reperfusion injury and the direct relationship between the severity of the observed vascular alterations and increasing duration of ischemia have been documented. The dynamic changes and histopathology of the microcirculation included constriction of the arteries, swelling of endothelial and leukocytes, and erythrocyte rouleaux formation during ischemia. As ischemia duration was lengthened, the degree of these changes increased correspondingly. The changes on reperfusion were disruption of blood flow patterns, vortex formation, regional stasis, adhesion and migration of leukocytes, focal hemorrhage, edema, vasospasm, and platelet aggregation. The deleterious effects of systemic acidosis, interstitial hemorrhage, denervation, and prolonged venous occlusion were subsequently documented. The application of information gained from this series of laboratory experiments has resulted in continued improvement in the success rate in clinical microvascular surgery.
采用大鼠提睾肌微循环的直接视频显微镜检查，并辅以再植、血管挤压以及损伤和恢复后肌肉功能的动物模型，来研究再灌注失败的发生情况。显然，血液回流失败可能由多种因素诱发，这些因素可分为缺血、内膜损伤以及全身或局部反应等类别，这被称为无复流三联征。构成无复流三联征三边的各组成部分能够以复杂的方式相互作用，任何单一因素或因素组合都能够引发导致再灌注失败的事件。再灌注损伤明显的区域特性以及所观察到的血管改变的严重程度与缺血持续时间增加之间的直接关系已得到证实。微循环的动态变化和组织病理学表现包括缺血期间动脉收缩、内皮细胞和白细胞肿胀以及红细胞缗钱状形成。随着缺血持续时间延长，这些变化的程度相应增加。再灌注时的变化包括血流模式紊乱、漩涡形成、局部血流停滞、白细胞黏附和迁移、局灶性出血、水肿、血管痉挛以及血小板聚集。随后证实了全身酸中毒、间质出血、去神经支配和长时间静脉阻塞的有害影响。从这一系列实验室实验中获得的信息的应用，使得临床微血管手术的成功率不断提高。
