地塞米松及碱性成纤维细胞生长因子联合应用防治超长任意型皮瓣缺血坏死实验探究.doc

地塞米松及碱性成纤维细胞生长因子联合应用防治超长任意型皮瓣缺血坏死实验探究[摘要]目的：探讨联合应用地塞米松和碱性成纤维细胞生长因子（bFGF）对大鼠背部超长任意皮瓣成活的影响，并进一步探讨大鼠血清中TNF-α及皮瓣中内皮细胞的细胞间粘附分子1（ICAM-1）发挥作用的机制。方法：采用大鼠背部皮瓣模型，术后即刻腹腔内一次性大剂量注射地塞米松，皮瓣下均匀滴注bFGF，术后24h内观察TNF-α及ICAM-1的变化，术后7天观察皮瓣成活率及组织学变化。结果：皮瓣成活率联合用药组（58.2±5.2）%＞bFGF组（50.5±3.9）%＞地塞米松组（48.7±4.2）%＞对照组（39.5±3.7）%，（F=32.08，P＜0.01）；联合用药组与地塞米松组较对照组及bFGF组血清中TNF-α含量达高峰时间更晚，峰值更低，且各组均于术后24h下降明显；各组于术后4h皮瓣组织的上皮细胞、血管内皮细胞和成纤维细胞的胞浆中均呈现ICAM-1的mRNA表达，并均于术后8h呈现ICAM-1阳性蛋白表达高峰， 对照组及bFGF组明显高于联合用药组和地塞米松组（P＜0.01），之后缓慢下降，术后12h仍保持较高水平。结论：地塞米松和bFGF均能促进皮瓣成活，且地塞米松+bFGF促进皮瓣成活优于单用地塞米松和单用bFGF。地塞米松能够延迟血清中TNF-α达到峰值的时间，显著降低其峰值含量，并通过抑制皮瓣中ICAM-1，干预炎症反应起始过程，从而减轻皮瓣炎症反应。 [关键词]地塞米松；碱性成纤维细胞生长因子；皮瓣；缺血坏死；成活率；TNF-α；ICAM-1 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2010）04-0591-04 Experimental study of the application that Dexamethasone combined with basic fibroblast growth factor(bFGF) to prevent ischemia and necrosis from ultra-long radom skin flap LIN Jie,QIU Shu-lin (Department of Plastic Surgery,Hebei People’S Hospital,Shijiazhuang 050051,Hebei,China) Abstract:ObjectiveTo study the combined effects of Dexamethasone and basic fibroblast growth factor (bFGF) of the random flap survival on rat’s dorsal, and further explore the levels of TNF-α in serum and how is the mechanism that the intercellular adhesion molecule-1 (ICAM-1) in endothelial cells of skin flap to play a role.MethodsThe rat dorsal skin flap model, a one-time immediately after high-dose intraperitoneal injection of Dexamethasone, drip bFGF equably under the flap, observed the changes of TNF-α and ICAM-1within 24h, post 7 days view the survival rate of the flap and histological changes. Results The survival rate of flap combined group (58.2 ± 5.2)% bFGF group (50.5 ± 3.9)% Dexamethasone group (48.7 ± 4.2)% the control group (39.5 ± 3.7)%, (F = 32.08, P0.01). The levels of TNF-α in serum of combined group and Dexamethasone group reached a peak time later than in the control group and bFGF group, and the peak is lower, and all groups were significa