Ischemia/reperfusion injury of porcine limbs after extracorporeal perfusion
Ischemia/reperfusion injury of porcine limbs after extracorporeal perfusion
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DOI：
10.1016/j.jss.2012.05.088
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发表时间：
2013-05-01
影响因子：
2.2
通讯作者：
Voegelin, Esther
中科院分区：
文献类型：
--
作者：
Mueller, Sabine;Constantinescu, Mihai A.;Voegelin, Esther
背景：长时间缺血后断肢的血运重建会因再灌注损伤而变得复杂。方法：将32只猪的前肢按缺血时间分为4组：I组：6 h，II组：12 h，III组：0 h+再植，IV组：6 h+再植。除Ⅱ组灌注5 h外，其余各组均采用ECC灌注自体血12 h。组III和组IV的肢体异位再植，随访7天。所有组均以同侧肢体为对照。组织，血浆和血清进行了分析的I/R injure.Results的程度：组织湿/干比内或组间无显着差异。这一发现得到了组织学的证实，但与基线相比，第IV组肌肉损伤增加（P = 0.016）。补体C3沉积仅在IV组肌肉（P = 0.031）、II组神经（P = 0.046）和II组血管（P = 0.037）中增加。IV组肌肉和神经组织是唯一在灌注结束时具有显著IgM抗体沉积的组织（P = 0.031）。再植后数值再次正常。灌注期间发现补体活性降低和IL-6、IL-8、MCP-1、VEGF、PDGF-bb、bFGF和补体裂解产物升高，但再植后再次恢复正常。硫酸肝素蛋白多糖和血管性血友病因子染色证实最小的激活内皮cells.Conclusion：结果表明，延长肢体保存使用ECC对I/R诱导的组织损伤的影响最小。骨外灌注是一种潜在的保肢技术，鼓励进一步研究用于肢体血运重建。(C)2013 Elsevier Inc. All rights reserved.
Background: Revascularization of amputated extremities after prolonged ischemia is complicated by reperfusion injury. We assessed ischemia/reperfusion (I/R) injury of porcine extremities after prolonged preservation using extracorporeal circulation (ECC).Methods: Forelimbs of 32 pigs were divided into four groups based on ischemia times: group I: 6 h, group II: 12 h, group III: 0 h plus replantation, and group IV: 6 h plus replantation. Limbs were perfused with autologous blood using ECC for 12 h except group II with only 5 h perfusion. Limbs from groups III and IV were heterotopically replanted with a 7-d follow-up. Contralateral limbs served as controls in all groups. Tissue, plasma, and serum were analyzed for the extent of I/R injury.Results: No significant differences in tissue wet/dry ratios were found within or between groups. This finding was confirmed by histology, except for an increased damage in group IV muscles compared with baseline (P = 0.016). Complement C3 deposition was only increased in group IV muscle (P = 0.031), group II nerves (P = 0.046), and group II vessels (P = 0.037). Group IV muscle and nerve tissues were the only ones with significant IgM antibody deposition (P = 0.031) at end of perfusion. Values were normal again after replantation. Reduced complement activity and elevated IL-6, IL-8, MCP-1, VEGF, PDGF-bb, bFGF, and complement split products were found during perfusion but were normal again after replantation. Staining for heparin sulfate proteoglycans and von Willebrand factor confirmed minimal activation of endothelial cells.Conclusion: The results demonstrate that prolonged limb preservation using ECC has minimal impact on I/R-induced tissue injury. Extracorporeal perfusion is a potential limb-preserving technique encouraging further studies for use in limb revascularization. (C) 2013 Elsevier Inc. All rights reserved.