摘要：
BACKGROUND: Early application of hyperbaric oxygen adjuvant therapy can relieve blisters, swelling and other symptoms, and thus improves the survival rate of skin flaps. Edaravone can effectively eliminate free radicals in the injured area of skin flaps. OBJECTIVE: To investigate the effect and mechanism of hyperbaric oxygen combined with edaravone on the survival rate of avulsed flap in rabbits. METHODS: Fifty-four healthy New Zealand white rabbits were provided by Laboratory Animal Center of Medical Collage of Soochow University. A 1.5 cm x 8 cm pedicled rectangle flap of the rabbit central artery was made on the middle of the rabbit left ear back, and created crush injury using special device. The 48 model rabbits were randomly divided into four groups (n=12/group), and received no intervention (control group), hyperbaric oxygen therapy, 3 mg/kg·d edaravone injection via tail vein, or hyperbaric oxygen therapy combined with edaravone (combination group), for 3 continuous days. The microcirculation of skin flap was observed at 3 days after treatment. The flap survival area was measured at 7 days after treatment. The survived flap was removed for hematoxylin-eosin staining. The expression levels of intercellular adhesion molecule-1 and vascular cell adhesion molecule 1 in flap tissue were detected by RT-PCR and western blot assay. RESULTS AND CONCLUSION: (1) Laser doppler and infrared thermal imaging system showed that the blood perfusion reached the distal segment of skin flap in the combination group, reached the middle segment of skin flap in the hyperbaric oxygen and edaravone groups, and reached the proximal segment of skin flap in the control group. (2) The survival rate of flap in the combination group was significantly higher than that in the other three groups (P ＜ 0.05). The survival rate in the edaravone and hyperbaric oxygen groups was significnatly higher than that in the control group (P ＜ 0.05). (3) The degree of inflammatory infiltration in the combination group was significantly low, and the degree of inflammatory infiltration in the control group was significantly higher than that in the hyperbaric oxygen and edaravone groups. (4) The mRNA and protein expression levels of intercellular adhesion molecule-1 and vascular cell adhesion molecule 1 detected by RT-PCR and western blot assay were lowest in the combination group (P ＜ 0.05), and the levels in the hyperbaric oxygen and edaravone groups were significantly lower than those in the control group (P ＜ 0.05). (5) To conclude, hyperbaric oxygen combined with edaravone can effectively promote the survival of rabbit ear avulsed skin flap, which is related to the decreased expression of intercellular adhesion molecule-1 and vascular cell adhesion molecule 1.%背景:早期给予高压氧辅助治疗对外伤皮瓣术后患者进行处理, 能够减轻水疱、肿胀等症状, 使皮瓣的成活率提高, 依达拉奉能够有效清除皮瓣损伤区自由基.目的:探讨高压氧处理联合依达拉奉治疗对兔撕脱皮瓣成活的影响及机制.方法:54只健康新西兰白兔由苏州医学院实验动物中心提供.于兔左耳背中央形成1.5 cm×8 cm中央动脉为蒂的矩形皮瓣, 应用特殊装置造成碾压撕脱伤, 造模成功48只, 随机分为4组, 每组12只, 原位缝合后各组连续治疗3d.对照组不予任何处理;高压氧组予以高压氧治疗;依达拉奉组尾静脉注射依达拉奉3 mg/ (kg?d);联合组予以高压氧治疗的同时予以依达拉奉治疗;在治疗后第3天观察皮瓣的微循环变化, 治疗后第7天测量皮瓣的成活面积, 取存活皮瓣组织苏木精-伊红染色进行组织学观察, RT-PCR和Western Blot检测皮瓣组织细胞间黏附分子1、血管内皮细胞黏附分子1的表达.结果与结论:①激光多普勒和红外线热成像系统检查显示, 在联合组血流灌注能达到皮瓣的远端, 高压氧组和依达拉奉组血流灌注能够达到皮瓣的中段, 而对照组仅能达到近段;②联合组皮瓣存活显著高于其他3组 (P ＜0.05), 依达拉奉组和高压氧组显著高于对照组 (P ＜0.05);③联合组炎性细胞浸润程度极低, 而对照组炎性细胞浸润程度明显高于高压氧组和依达拉奉组;④RT-PCR和Western Blot检测示细胞间黏附分子1、血管内皮细胞黏附分子1基因和蛋白的表达联合组最低 (P ＜0.05), 高压氧组和依达拉奉组显著低于对照组 (P ＜0.05);⑤结果说明, 高压氧处理联合联合依达拉奉治疗能够有效促进兔耳撕脱皮瓣成活, 其机制与降低兔耳皮瓣损伤过程中细胞间黏附分子1、血管内皮细胞黏附分子1的表达有关.
