Thomson I A, Egginton S, Simms M H, Hudlická O
Department of Surgery, Selly Oak Hospital, Birmingham, UK.
Int J Microcirc Clin Exp. 1996 Nov-Dec;16(6):284-90. doi: 10.1159/000179187.
In a placebo-controlled trial skeletal muscle biopsies were taken proximal and distal to the site of arterial stenosis, before cross-clamp and 20 min following reperfusion, in 8 well-matched critical limb ischaemia patients undergoing femorodistal bypass. Capillary endothelial swelling-a sign of reperfusion injury-was assessed following infusion with iloprost, a prostacyclin analogue, the prolonged beneficial effect of which on vascular graft flow rates has been demonstrated previously. Electron microscopy and image analysis of calf capillaries confirmed that critical limb ischemia patients had endothelial cell swelling before bypass, and that cross-clamp ischaemia caused further endothelial swelling in the placebo group. Samples from muscles proximal to the site of the bypass showed similar changes, indicating that systemic capillary damage occurs in muscle remote from the area of ischaemia. Iloprost treatment prevented endothelial swelling and increased the mean capillary lumen cross-sectional area. Iloprost, therefore, has a potentially beneficial effect on capillary function by limiting reperfusion injury during femorodistal bypass.
在一项安慰剂对照试验中，对8例接受股腘动脉搭桥术的配对良好的严重肢体缺血患者，在动脉狭窄部位近端和远端进行骨骼肌活检，分别在阻断血流前和再灌注后20分钟进行。在用前列环素类似物伊洛前列素输注后，评估毛细血管内皮肿胀（再灌注损伤的一个迹象），此前已证明其对血管移植物流速具有延长的有益作用。对小腿毛细血管进行电子显微镜检查和图像分析证实，严重肢体缺血患者在搭桥术前存在内皮细胞肿胀，并且在安慰剂组中，阻断血流缺血导致内皮进一步肿胀。来自搭桥部位近端肌肉的样本显示出类似变化，表明在远离缺血区域的肌肉中发生了全身性毛细血管损伤。伊洛前列素治疗可预防内皮肿胀，并增加平均毛细血管腔横截面积。因此，伊洛前列素通过限制股腘动脉搭桥术中的再灌注损伤，对毛细血管功能具有潜在的有益作用。
