山莨菪碱结合腔内成形术对膝下动脉阻塞病治疗作用的研究
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摘要
目的：
1、观察山莨菪碱对SD大鼠缺血后肢侧支循环建立的影响。
2、观察山莨菪碱结合腔内成形术对膝下动脉阻塞性疾病的治疗作用。
方法：
1.建立SD大鼠后肢缺血模型,随机分为缺血治疗组(15只)和缺血对照组(15只),分别给予山莨菪碱注射液8 mg/(kg×d)稀释至0.5 ml和等量生理盐水,于缺血下肢分5点进行肌肉注射,连续14 d,观察双侧后肢于造模术后即刻、7 d、14 d、28 d不同时间点皮温差的变化和术后28 d缺血后肢肌肉组织中的微血管密度。
2.将膝下动脉阻塞性疾病Ⅱ期患者40例行腔内成形术后随机分为使用山莨菪碱注射液治疗的山莨菪碱组和未使用山莨菪碱注射液治疗的空白对照组,分别于术前1d及术后1 d、7 d、14 d、28 d,测量患者腋温踝温差、踝肱指数、脉搏血氧饱和度、血清TC、血清TG、血清HDL-C、血清LDL-C、血清CRP及血清NO浓度。
结果：
1、造模后,随着时间的延长,两组大鼠健侧后肢与缺血后肢之间的皮温差逐渐减小(P<0.05),且缺血治疗组较缺血对照组皮温差更小(P<0.05),均有统计学意义;缺血治疗组缺血肌肉组织中MVD较缺血对照组高(P<0.05),有统计学意义。
2、术后两组患者踝温成上升趋势,腋温与踝温的温差呈减小趋势,且山莨菪碱组较空白对照组明显(P<0.05)；术后两组患者ABI均呈上升趋势,但组间无明显差异；术后两组患者SpO2均持续升高,且山莨菪碱组较空白对照组升高明显；术前及术后各时间点两组患者之间血清TC、血清TG、血清HDL-C、血清LDL-C均无明显差异；两组患者血清CRP于术后第1 d暂时升高,两组之间无明显差异,随后,血清CRP下降,且山莨菪碱组较空白对照组下降明显；两组患者血清NO浓度术后出现暂时性的降低,随即呈上升趋势,且山莨菪碱组升高更明显(P<0.05)。
结论：
1.山莨菪碱能促进大鼠缺血后肢侧支循环的建立,其机制可能与山莨菪碱能促进体内某种血管生成因子的分泌或释放有关。
2.山莨菪碱对于膝下动脉阻塞性疾病腔内成形术后患者的血清TG、血清TC、血清HDL-C、血清LDL-C以及ABI均无明显改善作用,但可以改善术后患肢的踝温及脉搏血氧饱和度,并能减轻炎症反应,降低血清CRP浓度,促进血清NO的分泌和释放,从而提高腔内成形术的近期疗效,利于远期通畅。其机制可能是通过解除小血管痉挛,扩张血管,促进侧支循环建立,增加血流,改善微循环以及减轻炎症反应等作用实现的。
OBJECTIVES:
1. To study the effect of anisodamine for the SD rat ischemic hind limb collateral circulation.
2. To study the effect of anisodamine combined angioplasty for inferior genicular artery occlusive disease.
METHODS:
1. To establish the SD rat ischemic hindlimb model, and the thirty SD rat were randomly divided into ischemic treatment group(15 cases)and control group(15 cases). Ischemic treatment group was treated with anisodamine 8 mg/(kg×d)diluted to 0.5 ml,and Sub-5 places in the ischemic lower limb for intramuscular injection consecutive 14-day.As well as control group was treated with equivalent of 0.9% sodium chloride injection,and Sub-5 places in the ischemic lower limb for intramuscular injection consecutive 14-day.Hind limbs in modeling observed immediately after surgery,7 days after surgery,14 days after surgery,28 days after surgery at different time points, changes in skin temperature and 28 days after ischemic hindlimb muscle tissue of the microvessel density.
2. The patients 40 cases with the inferior genicular artery occlusive disease after transluminal angioplasty were divided randomly into the group with anisodamine (anisodamine treatment group) and the group without anisodamine (blank control group). To measure the differences between axillary temperature and ankle temperature, ankle brachial index, transcutaneous oxygen saturation, serum TC, serum TG, serum HDL-C, serum LDL-C, serum CRP and serum NO,1 day before surgery, respectively, after 1 day and after 7 days,14 days,28 days.
RESULTS:
1. After modeling, two groups of rats contralateral hind limbs and ischemic hind limb skin temperature difference between the gradual reduction in Small(P<0.05), And ischemia treated group compared with ischemic control group, skin temperature smaller (P<0.05), were statistically significant. The ischemia treated group compared with ischemic control group, the MVD in muscle tissue higher(P<0.05), with statistical significance.
2. Postoperative, two groups of patients with ankle skin temperature were into a rising trend,and the temperature difference between axillary skin temperature and the ankle skin temperature were continuous decrease,and anisodamine treatment group than blank control group were more obvious (P<0.05),with a significant difference. The ABI of the two groups of patients were higher than preoperative, but no difference between the two groups. Percutaneous oxygen saturation of the two groups of patients were higher than preoperative,and anisodamine treatment group is more evident. Two groups of patients serum cholesterol, triglycerides, high density lipoproteins and low density lipoprotein were no significant change. The first day after surgery, the serum C-reaction protein were increased temporarily but no difference between the two groups. With the extension of treatment time the serum C-reaction protein were tended to decrease, and anisodamine treatment group is more evident. The first day after surgery, the concentration of nitric oxide were decrease temporarily, then increased, and anisodamine treatment group is more evident (P<0.05)
CONCLUSIONS:
1. Anisodamine can promote the establishment of collateral circulation of hind limb ischemia in rats, The mechanism may be related to anisodamine can promote some kind of angiogenine in vivo secretion or release.
2. Anisodamine for inferior genicular artery occlusive disease,percutaneous transluminal angioplasty in patients with serum TG, serum TC, serum HDL-C, serum LDL-C, as well as no significant improvement in the role of ABI, but can improve the ankle skin temperature with lower limb ischemia and transcutaneous oxygen saturation, and reduce the inflammatory response and the serum CRP, and promote the secretion and release of serum NO, and improve short-term efficacy of percutaneous transluminal angioplasty and reduce restenosis rates. Its possible mechanism is by lifting the small blood vessels spasm, distending of blood vessels, promoting the establishment of collateral circulation, increasing blood flow, and improving microcirculation to achieve.
1、观察山莨菪碱对SD大鼠缺血后肢侧支循环建立的影响。
2、观察山莨菪碱结合腔内成形术对膝下动脉阻塞性疾病的治疗作用。
方法：
1.建立SD大鼠后肢缺血模型,随机分为缺血治疗组(15只)和缺血对照组(15只),分别给予山莨菪碱注射液8 mg/(kg×d)稀释至0.5 ml和等量生理盐水,于缺血下肢分5点进行肌肉注射,连续14 d,观察双侧后肢于造模术后即刻、7 d、14 d、28 d不同时间点皮温差的变化和术后28 d缺血后肢肌肉组织中的微血管密度。
2.将膝下动脉阻塞性疾病Ⅱ期患者40例行腔内成形术后随机分为使用山莨菪碱注射液治疗的山莨菪碱组和未使用山莨菪碱注射液治疗的空白对照组,分别于术前1d及术后1 d、7 d、14 d、28 d,测量患者腋温踝温差、踝肱指数、脉搏血氧饱和度、血清TC、血清TG、血清HDL-C、血清LDL-C、血清CRP及血清NO浓度。
结果：
1、造模后,随着时间的延长,两组大鼠健侧后肢与缺血后肢之间的皮温差逐渐减小(P<0.05),且缺血治疗组较缺血对照组皮温差更小(P<0.05),均有统计学意义;缺血治疗组缺血肌肉组织中MVD较缺血对照组高(P<0.05),有统计学意义。
2、术后两组患者踝温成上升趋势,腋温与踝温的温差呈减小趋势,且山莨菪碱组较空白对照组明显(P<0.05)；术后两组患者ABI均呈上升趋势,但组间无明显差异；术后两组患者SpO2均持续升高,且山莨菪碱组较空白对照组升高明显；术前及术后各时间点两组患者之间血清TC、血清TG、血清HDL-C、血清LDL-C均无明显差异；两组患者血清CRP于术后第1 d暂时升高,两组之间无明显差异,随后,血清CRP下降,且山莨菪碱组较空白对照组下降明显；两组患者血清NO浓度术后出现暂时性的降低,随即呈上升趋势,且山莨菪碱组升高更明显(P<0.05)。
结论：
1.山莨菪碱能促进大鼠缺血后肢侧支循环的建立,其机制可能与山莨菪碱能促进体内某种血管生成因子的分泌或释放有关。
2.山莨菪碱对于膝下动脉阻塞性疾病腔内成形术后患者的血清TG、血清TC、血清HDL-C、血清LDL-C以及ABI均无明显改善作用,但可以改善术后患肢的踝温及脉搏血氧饱和度,并能减轻炎症反应,降低血清CRP浓度,促进血清NO的分泌和释放,从而提高腔内成形术的近期疗效,利于远期通畅。其机制可能是通过解除小血管痉挛,扩张血管,促进侧支循环建立,增加血流,改善微循环以及减轻炎症反应等作用实现的。
OBJECTIVES:
1. To study the effect of anisodamine for the SD rat ischemic hind limb collateral circulation.
2. To study the effect of anisodamine combined angioplasty for inferior genicular artery occlusive disease.
METHODS:
1. To establish the SD rat ischemic hindlimb model, and the thirty SD rat were randomly divided into ischemic treatment group(15 cases)and control group(15 cases). Ischemic treatment group was treated with anisodamine 8 mg/(kg×d)diluted to 0.5 ml,and Sub-5 places in the ischemic lower limb for intramuscular injection consecutive 14-day.As well as control group was treated with equivalent of 0.9% sodium chloride injection,and Sub-5 places in the ischemic lower limb for intramuscular injection consecutive 14-day.Hind limbs in modeling observed immediately after surgery,7 days after surgery,14 days after surgery,28 days after surgery at different time points, changes in skin temperature and 28 days after ischemic hindlimb muscle tissue of the microvessel density.
2. The patients 40 cases with the inferior genicular artery occlusive disease after transluminal angioplasty were divided randomly into the group with anisodamine (anisodamine treatment group) and the group without anisodamine (blank control group). To measure the differences between axillary temperature and ankle temperature, ankle brachial index, transcutaneous oxygen saturation, serum TC, serum TG, serum HDL-C, serum LDL-C, serum CRP and serum NO,1 day before surgery, respectively, after 1 day and after 7 days,14 days,28 days.
RESULTS:
1. After modeling, two groups of rats contralateral hind limbs and ischemic hind limb skin temperature difference between the gradual reduction in Small(P<0.05), And ischemia treated group compared with ischemic control group, skin temperature smaller (P<0.05), were statistically significant. The ischemia treated group compared with ischemic control group, the MVD in muscle tissue higher(P<0.05), with statistical significance.
2. Postoperative, two groups of patients with ankle skin temperature were into a rising trend,and the temperature difference between axillary skin temperature and the ankle skin temperature were continuous decrease,and anisodamine treatment group than blank control group were more obvious (P<0.05),with a significant difference. The ABI of the two groups of patients were higher than preoperative, but no difference between the two groups. Percutaneous oxygen saturation of the two groups of patients were higher than preoperative,and anisodamine treatment group is more evident. Two groups of patients serum cholesterol, triglycerides, high density lipoproteins and low density lipoprotein were no significant change. The first day after surgery, the serum C-reaction protein were increased temporarily but no difference between the two groups. With the extension of treatment time the serum C-reaction protein were tended to decrease, and anisodamine treatment group is more evident. The first day after surgery, the concentration of nitric oxide were decrease temporarily, then increased, and anisodamine treatment group is more evident (P<0.05)
CONCLUSIONS:
1. Anisodamine can promote the establishment of collateral circulation of hind limb ischemia in rats, The mechanism may be related to anisodamine can promote some kind of angiogenine in vivo secretion or release.
2. Anisodamine for inferior genicular artery occlusive disease,percutaneous transluminal angioplasty in patients with serum TG, serum TC, serum HDL-C, serum LDL-C, as well as no significant improvement in the role of ABI, but can improve the ankle skin temperature with lower limb ischemia and transcutaneous oxygen saturation, and reduce the inflammatory response and the serum CRP, and promote the secretion and release of serum NO, and improve short-term efficacy of percutaneous transluminal angioplasty and reduce restenosis rates. Its possible mechanism is by lifting the small blood vessels spasm, distending of blood vessels, promoting the establishment of collateral circulation, increasing blood flow, and improving microcirculation to achieve.
引文
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[1]Nguyen L L, Moneta G L, Conte M S, et al. Prospective multicenter study of quality of life before and after lower extremity vein bypass in 1404 patiens with critical limb ischemia[J].J Vasc Surg,2006,44(5):977-983.
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[3]Keeling W B, Shames M L, Stone P A, et al. Plaque excision with the Silverhawk catheter: early results in patients with claudication or critical limb ischemia[J]. J Vasc Surg, 2007,45(1):25-31.
[4]Lenti M, Cieri E, Rango P,et al. Endovascular treatment of long lesions of the superficial femoral artery:results from a multiceuter registry of a spiral, covered polytetrafluoroethylene stent[J].J Vasc Surg,2007,45(1):32-39.
[5]孙庆峰,姜维良,李宪伟,等.支架植入术联合取栓术治疗长段骼动脉闭塞[J].中国实用外科杂志,2008,28(10)：872-873.
[6]Schillinger M,Sabeti S, Dick P, et al. Sustained benefit at 2 years of primary femoropopliteal stenting compared with balloon angioplasty with optional stenting[J]. Circulation,2007,115(21):2745-2749.
[7]Krankenberg H, Schlter M, Steinkamp H J, et al.Nitinol stent implantation versus percutaneous transluminal angioplasty in superficial femoral artery lesions up to 10 cm in length:the femoral artery stenting trial (FAST)[J]. Circulation,2007,116(3): 285-292.
[8]Schillinger M, Sabeti S, Loewe C, et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery[J].N Engl J Med,2006,354(18):1879-1888.
[9]Faglia E, Dallapaola L,Clerici G,et al. Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993. consecutive patients hospitalized and followed between 1999 and 2003[J].Eur J Vasc Endovasc Surg,2005,29(6):620-627.
[10]Scott E C, Biuckins A,Light R E, et al. Subintimal angioplasty for the treatment of cladication and critical limb ischemia 3-year results [J]. J Vasc Surg,2007,46(5):959-964.
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