【摘要】 背景:有研究表明,重组人促红细胞生成素可诱导内皮前细胞分化成新生内皮细胞,高压氧则为新生内皮细胞提供增殖所需的充足氧分,加速了新生血管的发生。目的:分析重组人红细胞生成素、高压氧及其联合应用时对大鼠背部逆行超长缺血皮瓣的影响。设计、时间及地点:随机分组,细胞形态学观察,于2008-04/09在山东大学实验动物中心进行。材料:40只Wistar大鼠,于背部制作逆行超长缺血皮瓣。方法:于大鼠背部按4∶1设计逆行超长缺血随意皮瓣,皮瓣原位缝合后按照不同的干预方式均分为4组,常压氧组:给予生理盐水+常压氧;高压氧组:高压氧+生理盐水;重组人促红细胞生成素组:重组人促红细胞生成素+常压氧;综合组:重组人促红细胞生成素+常压氧。干预方法:重组人促红细胞生成素的注射量为400IU/kg与生理盐水等量,1次/d,连用10d。高压氧为202.65kPa,体积分数为95%;常压氧为101kPa;体积分数为35%,给氧均于缝合后8h进行,1h/次,2次/d,共10d。主要观察指标:于缝合后10d测量各组皮瓣成活率。以血管内皮细胞生长因子和CD34作为血管标记行免疫组化染色,计数皮瓣新生血管密度。结果:定性分析:常压氧组局部坏死,腺体萎缩。高压氧组腺体形态较好,重组人促红细胞生成素组腺体增生,而综合组增生更加明显。定量分析:与常压氧组比较,后3组的血管密度值均增高(P<0.01),且呈递增趋势,以α=0.05的检验标准,各组之间的差别有显著性意义(P<0.01),方差分析结果显示重组人促红细胞生成素和高压氧之间存在协同作用,同时使用效果更好。结论:重组人促红细胞生成素和高压氧以及二者联合应用,可以促进缺血皮瓣下的毛细血管生成,提高皮瓣存活率并扩大皮瓣长宽比例,重组人促红细胞生成素促进皮瓣成活效果好于高压氧,二者同时使用效果更好。更多还原

【Abstract】 BACKGROUND:Recombinant human erythropoietin(rhEPO) can induce the differentiation of endothelial progenitor cells into new endothelial cells.Hyperbaric oxygen(HBO) provides enough oxygen for the proliferation of new endothelial cells and accelerates the occurrence of new endothelial cells.OBJECTIVE:To analyze the effects of rhEPO,HBO and their combination on ultra-long ischemic dorsal skin flap in rats.DESIGN,TIME AND SETTING:The randomized,cell morphology study was conducted at the Animal Experimental Center of Shandong University from April to September 2008.MATERIALS:Forty Wistar rats were selected to make ultra-long ischemic dorsal skin flap.METHODS:A long ischemic free skin flap was made on the back of each rat at 4:1,and assigned into 4 groups.Rats were treated with saline plus normal pressure oxygen(normal pressure oxygen group),HBO plus saline(HBO group),rhEPO plus normal pressure oxygen(rhEPO group),normal pressure oxygen plus rhEPO(combination group).The dosage of intervention:subcutaneous use of rhEPO(400 IU/kg) or saline equals to rhEPO in volume,once a day,for 10 days;HBO(202.65 kPa,95% oxygen concentration) or normal pressure oxygen(101 kPa,35% oxygen concentration),once 1 hour,twice a day,for 10 days.Oxygen was given 8 hours following suture.MAIN OUTCOME MEASURES:The survival rate of skin flap was measured at day 10 after suture.VEGF and CD34 of histological specimens were used as vascular marker to determine the level of microvessel density.RESULTS:Qualitative analysis:Local necrosis and gland atrophy were detected in the normal pressure oxygen group.Good gland morphology was seen in the HBO group.Gland hyperplasia was found in the rhEPO group,and the hyperplasia was more significant in the combination group.Quantitative analysis:Compared with the normal pressure oxygen group,microvessel density value was increased in the HBO group,rhEPO group and combination group(P < 0.01),in a tendency to increase.According to α=0.05,significant differences were detected among groups(P < 0.01).Results of analysis of variance showed that rhEPO and HBO had synergistic effects,and their combination could obtain good outcomes.CONCLUSION:The use of rhEPO,HBO and their combination can upregulate the microvascular density in ischemic skin flap,also can expand the ratio in random skin flap.The rhEPO has better therapeutic effects than HBO,and their combination have the optimal therapeutic effects in the ischemic skin flap.更多还原