罂粟碱不同给药途径对兔腹壁浅动脉皮瓣血管阻力影响的研究
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摘要
背景:随着显微外科的发展,皮瓣移植成为修复创伤组织缺损最有效的方法。皮瓣移植的血管口径一般在1～3mm间,这些血管在组织上有明显的肌层,对各种物理化学刺激具有高度敏感性,所以吻合口及附近的一段血管极易发生痉挛,是显微外科手术中和手术后的常见并发症。严重持久的血管痉挛导致移植组织缺血缺氧甚至坏死,导致手术失败。临床上在显微外科皮瓣移植术后,常用罂粟碱等血管舒张药预防和解除血管痉挛,增加皮瓣循环血流量,使皮瓣存活能力明显增强。给药途径主要有:(1)采用一日多次,连续数日臀部肌肉注射;(2)24小时连续静脉注射。虽然临床效果较好,但这两种方法仍存在着不同程度的缺陷。如果静脉注射药物速度掌握不好、剂量过大,易导致心律失常、血压下降等到严重不良反应,加重组织缺血缺氧;而臀部肌肉注射如果剂量过大,将导致病人难于耐受,剂量过小则解痉效果差。而且有研究表明罂粟碱30～60 mg肌注或静脉注射后经过吸收和分布,作用于远端的药物浓度甚微,经计算到达手指仅有几微克。但皮瓣局部应用扩血管药物尚未常规采用,且效果如何?目前国内尚无对皮瓣近距离注射血管扩张剂给药途径的系统研究。
目的:探讨定量(1.5 mg/Kg)罂粟碱不同给药途径对兔腹壁浅动脉皮瓣血管阻力的影响,寻找出一种最佳的给药途径,提高皮瓣存活率,并减少药物引起的不良反应和并发症,具有较大的实用价值。
材料与方法:①选用雄性新西兰兔24只,实验方法符合动物伦理学要求。采用完全随机设计,按给药途径把24只兔分成4组(n=6),即皮瓣蒂部皮下注射组、皮瓣中央皮下注射组、臀部肌肉注射组及静脉推注组。②建立下腹部腹壁浅动脉皮瓣模型。术后1 h～7 d,按实验方案要求的部位注射罂粟碱,剂量为1.5 mg/Kg,1次/d。③术后1 h～7 d,利用彩色多普勒超声监测、比较分析近距离靶部位(皮瓣蒂部、皮瓣中央皮下)、远距离全身(传统臀部肌肉注射、静脉推注)注射罂粟碱前,注射罂粟碱后10 min,60 min时间点的血流阻力指数。④在统计方法上,使用spss11.5统计软件包处理数据,各处理组间术前皮瓣血流阻力指数的比较和各处理组间术后皮瓣血流阻力指数的比较用完全随机方差分析Duncan多重比较法;各组内术前及术后注药前皮瓣血流阻力指数用配对t检验;各组间皮瓣各时间点的血流阻力指数显著性检验均采用完全随机方差分析Duncan多重比较法。上述各统计学处理均规定P＜0.05为差异有显著性意义。
结果:24只兔的实验数据全部进入结果分析。①术后各组皮瓣的血流阻力指数均高于术前(P＜0.05)。②术后注药后10min静脉注射组与皮瓣中央组的皮瓣血流阻力指数无显著性差异(P＞0.05),但均低于皮瓣蒂部注射组和臀甲⑸渥?有显著性差异(P＜0.05);手术后第1天、第2天、第4天注药后10min皮瓣蒂部注射组、静脉注射组和皮瓣中央皮下注射组之间皮瓣血流阻力指数比较无显著性差异(P＞0.05),但低于臀部肌肉注射组,差异具有显著性意义(P＜0.05);手术后第3天、第5天注药后10min皮瓣蒂部注射组、静脉注射组和臀部肌肉注射组之间皮瓣血流阻力指数比较无显著性差异(P＞0.05),但皮瓣中央皮下注射组皮瓣血流阻力指数最低,与其余三组差异具有显著性意义(P＜0.05);手术后第6天、第7天注药后10min皮瓣血流阻力指数无显著性差异(P＞0.05)。③手术后注药后1h各组之间的皮瓣血流阻力指数比较,无显著性差异(P＞0.05);手术后第1天、第2天、第3天注药后1h皮瓣中央皮下注射组的皮瓣血流阻力指数最低,与臀部肌肉注射组相比差异具有显著性意义(P＜0.05),与其他两组差异无显著性意义(P＞0.05);手术后第4天注药后1h皮瓣中央皮下注射组的皮瓣血流阻力指数最低,与其他3组差异具有显著性意义(P＜0.05);手术后第5天注药后1 h除臀部肌肉注射组略高于手术前(0.542±0.058)外,其他各组的皮瓣血流阻力指数均略低于手术前,3组之间差异无显著性意义(P＞0.05);手术后第6天、第7天注药后1 h各组之间皮瓣血流阻力指数比较,无显著性差异(P＞0.05)。
结论:①移植皮瓣术后应用罂粟碱,经皮瓣蒂部皮下注射、皮瓣中央皮下注射、臀部肌肉注射及静脉推注四种给药途径,均能明显降低皮瓣的血流阻力指数。②移植皮瓣术后应用罂粟碱,经皮瓣中央皮下注射给药降低皮瓣的血流阻力指数效果最好,臀肌注射给药降低皮瓣的血流阻力指数效果最差。
Background:With the development of microscopic surgery,transplantation of skin flaps has become the most effective method for repairing the traumatic tissue defection.There were visible muscle layer on the blood vessel,which has high sensitivity to all kinds of physical and chemical stimulation.So spasm occured to the anastomotic and the nearby section vessel very easily,which was the common complication during or after the microsurgical operation.The severe and lasting vasospasm resulted in transplanted tissue ischemia and hypoxia and even necrosis, thus induced the failure of operation.In clinical application,after operation of microscopic vascular of skin flaps,vasodilatator such as papaverine was frequently used to prevent and relieve vasospasm,increase cyclic blood flow of skin flaps and significantly reinforced skin flaps survivial capability.There were two major injection approaches:(1) using intramuscular injection in the buttocks many times per day for many days;(2) intravenous injection for 24 hours.Although clinical effects were good,the two methods still existed different degree of defect.If couldn't control the speed of drug in intravenous injection,or injected too much,which would easily lead to severe bad reaction such as arrhythmia and blood pressure decrease,and aggravate ischemia and hypoxia in transplanted tissue;to intramuscular injection in muscle of buttocks,if dosage is too great,patients could not tolerant,but dosage is too low,the effects of spasmolysis were poor.Experiment results also showed that papaverine has been absorbed and distributed by 30～60 mg after intramuscular injection or intravenous injection,the concentration of drug acted on the remote end was very tiny, by calculating only several microgram could reach fingers.However,vasodilator drugs has not been conventional used in locally applied of flaps,and how to effects? At present,there was not system study about injection approaches of vasodilators by close distance of flaps.
Objective:To investigate the influence of quantified papaverine(1.5 mg/kg) by different injection approaches on peripheral resistance of hypogastrium superficial epigastric artery skin flaps of rabbits,we explore the best administration approach to increase the survival ratio of skin flaps and reduce the adverse drug reactions and complications,which has considerable practical value.
Material and methods:①Twenty-four male New Zealand rabbits were selected and randomized into 4 groups(n=6):skin flaps pedicle subcutaneous injection group,skin flaps center subcutaneous injection group,intramuscular injection group and intravenous injection group.The experimental procedure was accorded with animal ethical standards.②Bilateral hypogastric flap models were set up,and quantified papaverine(1.5 mg/kg) was administrated in each group by different approaches 1-7 hours postoperatively,once per day.③The resistance index of skin flaps were observed and comparative analysis by color Doppler ultrasound before operation,before injection,10 minutes and 1 hour after injection with one week after operation at close-distance targeted position(skin flap pedicle, skin flap center) and long-distance systemic(intramuscular injection,intravenous injection).④The results were analyzed by SPSS11.5 statistical package including paired T test and duncan's test,A P value of＜0.05 was considered significant.
Results:Twenty-four rabbits were included in final analysis.①The resistance index of flap blood flow in each group after operation was higher than before operation(P＜0.05).②The postoperative index of flap blood in skin flaps center group at 10 minutes after injection was no significant difference from intravenous injection group(P＞0.05).But they were lower than skin flaps pedicle subcutaneous injection group and intramuscular injection group,both of them have a statistical signification(P＜0.05).There was no statistical difference among these postoperative resistance index of flap blood flow of the skin flaps pedicle subcutaneous injection group and skin flaps center subcutaneous injection group and intravenous injection group at 10 minutes after injection on the first and second and fourth day(P＞0.05). But they were significantly lower than the intramuscular injection group(P＜0.05). There was no statistical difference among these postoperative resistance index of flap blood flow of the skin flap pedicle subcutaneous injection group and intramuscular injection group and intravenous injection group at 10 minutes after injection on the third and fifth day(P＞0.05),but the postoperative resistance index of flap blood flow of the skin flap center subcutaneous injection group was the lowest than others and it was a statistical signification(P＜0.05).There was no statistical difference among these postoperative resistance index of flap blood flow of the all group at 10 minutes after injection on the sixth and seventh day(P＞0.05).③There was no statistical difference among these postoperative resistance index of flap blood flow of the all groups at 1 hour after injection(P＞0.05),the postoperative resistance index of flap blood flow of the skin flap center subcutaneous injection group was the lowest at 1 hour after injection on the first and second and third day,there was a statistical signification compared with the intramuscular injection group(P＜0.05),but no statistical difference compared with other two groups(P＞0.05).The postoperative resistance index of flap blood flow of the skin flap center subcutaneous injection group was the lowest at 1 hour after injection on fourth day,there was statistical signification(P＜0.05).The postoperative resistance index of flap blood flow of the intramuscular injection group was slightly higher than preoperative at 1 hour after injection on fifth day(0.542±0.058),the others three resistance index were slightly lower preoperative,there was no statistical difference among three groups(P＞0.05). There was no statistical difference among these postoperative resistance index of flap blood flow of the all group at 1 hour after injection on sixth and seventh day(P＞0.05).
Conclusion:①The papaverine could significantly decrease resistance index by skin flap pedicle subcutaneous injection and skin flap center intravenous injection and subcutaneous injection and intramuscular injection after operation.②After skin flap operating,papaverine injection in skin flap center achieves the best effect of decreasing resistance index,and intramuscular injection shows the worst effect of decreasing resistance.
目的:探讨定量(1.5 mg/Kg)罂粟碱不同给药途径对兔腹壁浅动脉皮瓣血管阻力的影响,寻找出一种最佳的给药途径,提高皮瓣存活率,并减少药物引起的不良反应和并发症,具有较大的实用价值。
材料与方法:①选用雄性新西兰兔24只,实验方法符合动物伦理学要求。采用完全随机设计,按给药途径把24只兔分成4组(n=6),即皮瓣蒂部皮下注射组、皮瓣中央皮下注射组、臀部肌肉注射组及静脉推注组。②建立下腹部腹壁浅动脉皮瓣模型。术后1 h～7 d,按实验方案要求的部位注射罂粟碱,剂量为1.5 mg/Kg,1次/d。③术后1 h～7 d,利用彩色多普勒超声监测、比较分析近距离靶部位(皮瓣蒂部、皮瓣中央皮下)、远距离全身(传统臀部肌肉注射、静脉推注)注射罂粟碱前,注射罂粟碱后10 min,60 min时间点的血流阻力指数。④在统计方法上,使用spss11.5统计软件包处理数据,各处理组间术前皮瓣血流阻力指数的比较和各处理组间术后皮瓣血流阻力指数的比较用完全随机方差分析Duncan多重比较法;各组内术前及术后注药前皮瓣血流阻力指数用配对t检验;各组间皮瓣各时间点的血流阻力指数显著性检验均采用完全随机方差分析Duncan多重比较法。上述各统计学处理均规定P＜0.05为差异有显著性意义。
结果:24只兔的实验数据全部进入结果分析。①术后各组皮瓣的血流阻力指数均高于术前(P＜0.05)。②术后注药后10min静脉注射组与皮瓣中央组的皮瓣血流阻力指数无显著性差异(P＞0.05),但均低于皮瓣蒂部注射组和臀甲⑸渥?有显著性差异(P＜0.05);手术后第1天、第2天、第4天注药后10min皮瓣蒂部注射组、静脉注射组和皮瓣中央皮下注射组之间皮瓣血流阻力指数比较无显著性差异(P＞0.05),但低于臀部肌肉注射组,差异具有显著性意义(P＜0.05);手术后第3天、第5天注药后10min皮瓣蒂部注射组、静脉注射组和臀部肌肉注射组之间皮瓣血流阻力指数比较无显著性差异(P＞0.05),但皮瓣中央皮下注射组皮瓣血流阻力指数最低,与其余三组差异具有显著性意义(P＜0.05);手术后第6天、第7天注药后10min皮瓣血流阻力指数无显著性差异(P＞0.05)。③手术后注药后1h各组之间的皮瓣血流阻力指数比较,无显著性差异(P＞0.05);手术后第1天、第2天、第3天注药后1h皮瓣中央皮下注射组的皮瓣血流阻力指数最低,与臀部肌肉注射组相比差异具有显著性意义(P＜0.05),与其他两组差异无显著性意义(P＞0.05);手术后第4天注药后1h皮瓣中央皮下注射组的皮瓣血流阻力指数最低,与其他3组差异具有显著性意义(P＜0.05);手术后第5天注药后1 h除臀部肌肉注射组略高于手术前(0.542±0.058)外,其他各组的皮瓣血流阻力指数均略低于手术前,3组之间差异无显著性意义(P＞0.05);手术后第6天、第7天注药后1 h各组之间皮瓣血流阻力指数比较,无显著性差异(P＞0.05)。
结论:①移植皮瓣术后应用罂粟碱,经皮瓣蒂部皮下注射、皮瓣中央皮下注射、臀部肌肉注射及静脉推注四种给药途径,均能明显降低皮瓣的血流阻力指数。②移植皮瓣术后应用罂粟碱,经皮瓣中央皮下注射给药降低皮瓣的血流阻力指数效果最好,臀肌注射给药降低皮瓣的血流阻力指数效果最差。
Background:With the development of microscopic surgery,transplantation of skin flaps has become the most effective method for repairing the traumatic tissue defection.There were visible muscle layer on the blood vessel,which has high sensitivity to all kinds of physical and chemical stimulation.So spasm occured to the anastomotic and the nearby section vessel very easily,which was the common complication during or after the microsurgical operation.The severe and lasting vasospasm resulted in transplanted tissue ischemia and hypoxia and even necrosis, thus induced the failure of operation.In clinical application,after operation of microscopic vascular of skin flaps,vasodilatator such as papaverine was frequently used to prevent and relieve vasospasm,increase cyclic blood flow of skin flaps and significantly reinforced skin flaps survivial capability.There were two major injection approaches:(1) using intramuscular injection in the buttocks many times per day for many days;(2) intravenous injection for 24 hours.Although clinical effects were good,the two methods still existed different degree of defect.If couldn't control the speed of drug in intravenous injection,or injected too much,which would easily lead to severe bad reaction such as arrhythmia and blood pressure decrease,and aggravate ischemia and hypoxia in transplanted tissue;to intramuscular injection in muscle of buttocks,if dosage is too great,patients could not tolerant,but dosage is too low,the effects of spasmolysis were poor.Experiment results also showed that papaverine has been absorbed and distributed by 30～60 mg after intramuscular injection or intravenous injection,the concentration of drug acted on the remote end was very tiny, by calculating only several microgram could reach fingers.However,vasodilator drugs has not been conventional used in locally applied of flaps,and how to effects? At present,there was not system study about injection approaches of vasodilators by close distance of flaps.
Objective:To investigate the influence of quantified papaverine(1.5 mg/kg) by different injection approaches on peripheral resistance of hypogastrium superficial epigastric artery skin flaps of rabbits,we explore the best administration approach to increase the survival ratio of skin flaps and reduce the adverse drug reactions and complications,which has considerable practical value.
Material and methods:①Twenty-four male New Zealand rabbits were selected and randomized into 4 groups(n=6):skin flaps pedicle subcutaneous injection group,skin flaps center subcutaneous injection group,intramuscular injection group and intravenous injection group.The experimental procedure was accorded with animal ethical standards.②Bilateral hypogastric flap models were set up,and quantified papaverine(1.5 mg/kg) was administrated in each group by different approaches 1-7 hours postoperatively,once per day.③The resistance index of skin flaps were observed and comparative analysis by color Doppler ultrasound before operation,before injection,10 minutes and 1 hour after injection with one week after operation at close-distance targeted position(skin flap pedicle, skin flap center) and long-distance systemic(intramuscular injection,intravenous injection).④The results were analyzed by SPSS11.5 statistical package including paired T test and duncan's test,A P value of＜0.05 was considered significant.
Results:Twenty-four rabbits were included in final analysis.①The resistance index of flap blood flow in each group after operation was higher than before operation(P＜0.05).②The postoperative index of flap blood in skin flaps center group at 10 minutes after injection was no significant difference from intravenous injection group(P＞0.05).But they were lower than skin flaps pedicle subcutaneous injection group and intramuscular injection group,both of them have a statistical signification(P＜0.05).There was no statistical difference among these postoperative resistance index of flap blood flow of the skin flaps pedicle subcutaneous injection group and skin flaps center subcutaneous injection group and intravenous injection group at 10 minutes after injection on the first and second and fourth day(P＞0.05). But they were significantly lower than the intramuscular injection group(P＜0.05). There was no statistical difference among these postoperative resistance index of flap blood flow of the skin flap pedicle subcutaneous injection group and intramuscular injection group and intravenous injection group at 10 minutes after injection on the third and fifth day(P＞0.05),but the postoperative resistance index of flap blood flow of the skin flap center subcutaneous injection group was the lowest than others and it was a statistical signification(P＜0.05).There was no statistical difference among these postoperative resistance index of flap blood flow of the all group at 10 minutes after injection on the sixth and seventh day(P＞0.05).③There was no statistical difference among these postoperative resistance index of flap blood flow of the all groups at 1 hour after injection(P＞0.05),the postoperative resistance index of flap blood flow of the skin flap center subcutaneous injection group was the lowest at 1 hour after injection on the first and second and third day,there was a statistical signification compared with the intramuscular injection group(P＜0.05),but no statistical difference compared with other two groups(P＞0.05).The postoperative resistance index of flap blood flow of the skin flap center subcutaneous injection group was the lowest at 1 hour after injection on fourth day,there was statistical signification(P＜0.05).The postoperative resistance index of flap blood flow of the intramuscular injection group was slightly higher than preoperative at 1 hour after injection on fifth day(0.542±0.058),the others three resistance index were slightly lower preoperative,there was no statistical difference among three groups(P＞0.05). There was no statistical difference among these postoperative resistance index of flap blood flow of the all group at 1 hour after injection on sixth and seventh day(P＞0.05).
Conclusion:①The papaverine could significantly decrease resistance index by skin flap pedicle subcutaneous injection and skin flap center intravenous injection and subcutaneous injection and intramuscular injection after operation.②After skin flap operating,papaverine injection in skin flap center achieves the best effect of decreasing resistance index,and intramuscular injection shows the worst effect of decreasing resistance.
引文
1. Schusterman, M .A., Miller, M J., Reece, G .P, et al .A single center's experience with 308 free flaps for repair of head and neck cancer defects.Plast.Reconsrt.Surg.1994, 93: 472.
2. Kroll, S .S., Schusterman, M .A., Reece, G .P, et al. Choice of flap and incidence of free flaps success.Plast.Reconsrt.Surg,1996, 98: 459.
3. Hidalgo, D.A., Disa, J.J., Cordeiro, P.G., et al. A review of 716 consecutive free flaps for oncologic surgical defects: Refinement in donor site selection and technique.Plast Reconstr.Surg,1998,102: 722.
4. Kind, G .M, Buntic, R .F, Buncke, G .M .,et al .The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants.Plast.Reconsrt. Surg,1998,101:1268.
5. Nichter LS, Sobieski MW, Edgerton MT. Efficacy of topical nitroglycerin for random-pattern skin-flap salvage, Plast Reconstr Surg, 1985, 75: 847-852.
6. James C .Yuen, M .D., and Zuliang Feng, M .D. Monitoring free flaps using the Laser Doppler flowmeter: five-year experience.Plast Reconsrt Surg,2000,105(1):55-61.
7. Hirigoyen, M .B., Urken, M .L., and Weinberg, H .Free flap monitoring: A review of current practice.Microsurgery,1995,16 :723.
8. Harrison DH, Girling M, Mott G. Methods of Assessing the viability of free flap transfer during the postoperative period. Clin Plast Surg 1983,10 : 21 -36.
9. Jones, M.D., Ranjan Gupta, M.D. Postoperative monitoring of pediatric toe-to-hand transfers with differential pulse oximetry. The Journal of Hand Surgery,2001, 26 (3): 525-529.
10. Angel, M.F., Mellow. C. G., Knight, K.R., and O'Brien, B.M. Secondary ischemia time in rodents: Contrasting complete pedicle interruption with venous obstruction.Plast. Reconsrt. Surg,1990, 85: 789
11. May JW, Chait LA, O'Brien BM, Hurley JV: The no-reflow phenomenon in experimental free flaps. Plast Reconstr Surg,1978, 61: 256.
12. Kerrigan CL, Daniel PK. Pharmacologic treatment of the failing skin flap. Plast Reconstr Surg, Nov 1982,70(5): 541-549.
13. Callegari PR, Taylor GI, Caddy CM, et al. An anatomic review of the delay phenomenon: I .Experimental studies. Plast Reconstr Surg, 1992, 89(3): 397-407.
14. Taylor GI, Corlett RJ, Caddy CM, et al. An anatomic review of the delay phenomenon: II. Clinical applications, Plast Reconstr Surg, 1992, 89(3): 408-416.
15. Forrest CR, Neligan P, Zhong A, et al. Acute adenosine treatment is effective in augmentation of ischemic tolerance in muscle flaps in the pig . Plast Reconstr Surg,Jan 1997, 99(1): 172-182.
16. Zahir KS, Syed SA, Zink JR,et al. Ischemic preconditioning improves the survival of skin and myocutaneous flaps in a rat model. Plast Reconstr Surg, Jul 1998,102(1):140-150.
17. Ishiguro N, Yabe Y, Shimizu T, et al. Basic fibroblast growth factor has a beneficial effect on the viability of random skin flaps in rats. Ann Plast Surg,1994,32(4): 356-360.
18. Wang BH, Ye C, Stagg CA, et al. Improved free musculocutaneous flap survival with induction of heat shock protein. Plast Reconstr Surg, 1998; 101(3): 776-784.
19. Schusterman MA, Miller MJ, Reece GP, et al. A single center's experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg 1994;93:472.
20. Kroll SS, Schusterman MA, Reece GP, et al.Chonice of flap and incidence of free flaps success. Plast Reconstr Surg 1996,98:459.
21. Hidalgo DA, Disa JJ, Cordeiro PG, et al. A review of 716 consecutive free flaps for oncologic surgical dedects: Refinement in donor site selection and technique.Plast Reconstr Surg 1998,102:722.
22. Kind GM, Buntic RF, Buncke GM, et al. The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants. Plast Reconstr Surg 1998,101:1268.
23. Jurell G, Hjemdahl P, Fredholm BB. On the mechanism by which antiadrenergic drugs increase survival of critical skin flaps. Plast Reconstr Surg 1983,72(4):518-525
24.Sastre N,Rodriguez A,Bias R.Skin flap neovascularization by means of a vasodilator.J Reconstr Microsurg 1987,3(3):265-268.
25.王培吉,王雅坤.应用罂粟碱和利多卡因预防和治疗微小血管吻合术后的血管痉挛[J].延边大学医学学报.2005,28(2):121-123.
26.王成琪,蒋纯志,张祚勇,等.植入型罂粟碱缓释剂在断指在植中的应用[J].中华显微外科杂志.1995,18(1):34-36.
27.张莉,李智贤,刘达恩,等.彩色多普勒超声显像应用于轴形皮瓣血管的检测[J].实用医学影像杂志.2005,6(1):36-38.
28.Fitzal F,Valentini D,Worseg A,et al.Evaluation of total vs.regional blood perfusion with a laser Doppler imaging system in the rat epigastric flap.J Reconstr Microgurg 2001,17(1):59-62.
29.Yuen JC,Feng Z.Disitinguuishing laser Doppler flowmetric responses between arterial and venous obstructions in flaps.J Reconstr Microsurg 2000,16(8):629-635.
30.Yuen JC,Feng Z.Monitoring ree flaps using the laser Doppler flowmeter:five-year experience.Plast Reconstr Surg 2000,105(1):55-61.
31.James L.Variations in flap blood flow and tissue PO2:A new technique for monitoring flap viability.Annals of Plastic Surgery,1988,20(1):43-47.
32.Achauer BM,Black KS,Litke DK:Transcutaneous po2 in flaps:a new method of survival prediction.Plast Reconstr Surg 1980,65:738.
33.Svedman,P.,Jacobsson,S.,Ponnert,L.,and Lindell,S.E.Transcutaneous oxygen tension in flaps.Chir.Plast,1982,6:201.
34.王宏图,张静华.新编药物临床手册[M].上海:上海医科大学出版社,1998:211.
35.Wilen G.Metabolism of 14C Papaverine in man.Jpharm Pharmacol,1982,34:264-268.
36.Maggi GC.Papaverine blood levels after administration of a sustained release preparation.Arzneinr Forsch/Drug Res.1997,27:1214-1219.
37.陈新谦,金有豫,汤光.新编药物手册[M].15版.北京:人民卫生出版社,2003:360.
38.彭司勋.药物化学.北京:化学工业出版社,1988:167.
39.刘芳龄,刘多三,饶明俐,等.尼莫地平和罂粟碱对实验性迟发性脑血管痉挛的作用[J].中华医学杂志.1996,76(2):132-134.
40.张跃伟,黄正松,五光伟,等.内皮素在血管内治疗迟发性脑血管痉挛前后含量变化的实验研究[J].临床放射性杂志.2004,20(7):536-538.
41.贺道华,马廉亭.罂粟碱、尼莫同治疗脑血管痉挛的疗效比较[J].暨南大学学报(自然科学版).2002,21(1):105-108.
42.芦奕,孙丕通,惠国桢,等.动脉持续灌注罂粟碱对兔脑血管痉挛的实验研究[J].江苏医药杂志.2004,30(5):334-337.
43.蒋栋毅,周岱.动脉内灌注罂粟碱治疗脑血管痉挛的实验研究[J].苏州医学院学报.2001,21(6):621-624.
44.郑毅,万峰,陈或,等.不同血管保存液对人桡动脉血管移植物的抗痉挛作用[J].中华实验外科学杂志.2004,21(8):1005-1006.
45.周金良,黄胜平.尼莫同、罂粟碱术野灌洗治疗侧裂入路术中血管痉挛效果比较[J].南通医学院学报.2004,24(3):341-342.
46.栾杰,唐勇,张旭辉,等.外用罂粟碱霜对扩张皮肤血流量及扩张皮瓣成活长度的影响[J].实用美容整形外科杂志.2002,13(4):209-212.
47.李景文,龙村,高国栋.尼可地尔及罂粟碱对冠状动脉旁路移植术大隐静脉血管桥血管舒张功能的影响[J].中国体外循环杂志.2005,3(3):164-166.
48.Lee P,Squier CA,Bardach J.Enhancement of tissue expansion by anticontractile agents[J].Plast Reconstr Surg,1985,76(4):604.
49.Matt BH,Squire CA Kelly KM,etal.Enhancement of expansion of guinea pigskin by local delivery of an anticontractile agent using a new bilumen expander[J].Ann Plast surg,1990,24(4):335.
50.吴钟琪,周宏灏,许树格.全科医学临床药物学.北京:科学出版社,1998:119.
51.范启申,王成琪.现代骨科显微手术学[M].北京:人民军医出版社,1995:25
52.王立峰,岳学军,智江.盐酸罂粟碱在断指再植中的应用体会[J].中国交通医学杂志.2005,19(2):140
53.Jurell G,Hjemdahl P,Fredholm BB.On the mechanism by which antiadrenergic drugs increase survival of critical skin flaps.Plast Reconstr Surg 1983,72(4):518-525
54.Sastre N,Rodriguez A,Blas R.Skin flap neovascularization by means of a vasodilator.J Reconstr Microsurg 1987,3(3):265-268.
55.Kroll,S.S.,Schusterman,M.A.,Reece,G.P.,et al.Choice of flap and incidence of free flaps success.Plast.Reconstr.Surg,1996,98:459.
56.Hidalgo,D.A.,Disa 57.Kind,G.M.,Bunitc,R.F.,Buncke,G.m.,et al.Theeffect of an implantable Doppler on the salvage of microvascular tissue transplants.Plast.Reconstr.Surg,1998,101:1268..
58.Hirigoyen MB,Urken ML,Weinberg H.Free flap monitoring:a review of current practice.Microsurgery,1995,16:723-727.
59.James L.Variations in flap blood flow and tissue PO2:A new technique for monitoring flap viability.Annals of Plastic Surgery,1988,20(1):43-47.
60.张莉,李智贤.超声影像检测轴型皮瓣血供的研究进展[G].2004全国医学影像技术学术会议论文汇编.2004:301-304.
61.Clouston JE,Numaguchi Y,Zoarski GH,et al.Intraarterial papaverine infusion for cerebral vasospasm after subarachnoid hemorrhage.AJNR Am J Neuroradiol 1995;16(1):27-38
62.Kaku Y,Yonekawa Y,Tsukahara T,et al.Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage.J Neurosurg 1992;77(6):842-847
63.王成琪,陈中伟,朱盛修.实用显微外科学[M].北京:人民卫生出版社.1992,104-105.
64.朱盛修,卢世壁.骨科显微手术学[M].北京:科学出版社.1983,48-49.
1. Schusterman, M .A., Miller, M J., Reece, G .P, et al .A single center's experience with 308 free flaps for repair of head and neck cancer defects.Plast.Reconsrt.Surg.1994, 93: 472.
2. Kroll, S .S., Schusterman, M .A., Reece, G .P, et al. Choice of flap and incidence of free flaps success.Plast.Reconsrt.Surg,1996, 98: 459.
3. Hidalgo, D.A., Disa, J.J., Cordeiro, P.G., et al. A review of 716 consecutive free flaps for oncologic surgical defects: Refinement in donor site selection and technique.Plast Reconstr.Surg,1998,102: 722.
4. Kind, G .M, Buntic, R .F, Buncke, G .M .,et al .The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants.Plast.Reconsrt. Surg,1998,101:1268.
5. Nichter LS, Sobieski MW, Edgerton MT. Efficacy of topical nitroglycerin for random-pattern skin-flap salvage, Plast Reconstr Surg, 1985, 75: 847-852.
6. James C .Yuen, M .D., and Zuliang Feng, M .D. Monitoring free flaps using the Laser Doppler flowmeter: five-year experience.Plast Reconsrt Surg,2000,105(1):55-61.
7. Hirigoyen, M .B., Urken, M .L., and Weinberg, H .Free flap monitoring: A review of current practice.Microsurgery,1995,16 :723.
8.Harrison DH,Girling M,Mott G.Methods of Assessing the viability of free flap transfer during the postoperative period.Clin Plast Surg 1983,10:21-36.
9.Jones,M.D.,Ranjan Gupta,M.D.Postoperative monitoring of pediatric toe-to-hand transfers with differential pulse oximetry.The Journal of Hand Surgery,2001,26(3):525-529.
10.Angel,M.F.,Mellow.C.G.,Knight,K.R.,and O'Brien,B.M.Secondary ischemia time in rodents:Contrasting complete pedicle interruption with venous obstruction.Plast.Reconsrt.Surg,1990,85:789
11.May JW,Chait LA,O'Brien BM,Hurley JV:The no-reflow phenomenon in experimental free flaps.Plast Reconstr Surg,1978,61:256.
12.Kroll,S.S.,Schusterman,M.A.,Reece,G.P.,et al.Choice of flap and incidence of free flaps success.Plast.Reconstr.Surg,1996,98:459.
13.Hidalgo,D.A.,Disa 14.Kind,G.M.,Bunitc,R.F.,Buncke,G.m.,et al.Theeffect of an implantable Doppler on the salvage of microvascular tissue transplants.Plast.Reconstr.Surg,1998,101:1268..
15.谢汉波,平祖衡,鲍同柱.彩色多普勒探查在带血管蒂皮瓣移植术的应用[J].中国超声医学杂志.1997,13(11):62-64.
16.张莉,李智贤,刘达恩等.不同类型血供轴型皮瓣轴心动脉超声显像的探讨 [J]. 中国超声医学杂志. 2006,22(1):58-60
17. Jone BM, Mayou BJ. The laser Dopple flowmete for microvascular monitoring. A preliminary report.Br J plast surg, 1982,35:147-149.
18. Heller, Levin LS, Klitzman B. Laser Doppler flowmete monitoring of free tissue transfers: blood flow in normal and complicated cases. Plast Reconstr Surg, 2001, 107(7):1739-1745.
18. Yuen JC, feng Z. Distinguishing laster Doppler flowmetric responses between arterial and venous obstructions in flaps. J Reconstr Microsurg,200,16(8):629-635.
19. Stone CA, Dubbins PA, Morris RJ.Use of cocor duplex Doppler imaging in the postoperative assessment of buried free flaps.Microsurgery, 2001, 21 (5):223-227.
20. Dooley TW, Welsh DF, Puckett CL.Noninvasive assessment of microvessels with the duplex scanner. J Hand surg, 1989,14A:670-673.
21. Gurunluoglu R,Bayramicli M, Sonmez A, Numanoglu A. A neurocutaneous island flap model: an experimental study in rats. Ann Plast Surg, 2000, 44(1):53-58.
22. Erisson E, Heden P. Method for skin blood flow studies in the pig.Scand J plast reconstr surg, 1988,22:229-232.
23. Cordeiro PG, santamaria E, Hu QY, et al.The timing and nature of
neovascularization of jejunal free flaps:an experimental study in a large animal model. Plast Reconstr Surg, 1999,103(7):1893-1901. 24.Yucel A, Bayramicli M. Effects of hyperbaric oxygen treatment and heparin on the survival of unipedicled venous flaps:an experimental study in rats. Ann Plast Surg,2000, 44(3):295-303.
25. Ergun H, Cilingir MG, Apaydin I, et al. The effect of dipyrone on survival of skin flaps. Scand J Plast Reconstr Surg Hand Surg, 2001, 35(1):19-22.
26. Whitney TM, Lineaweaver WC, Billys JB, et al. Improved salvage of complicated microvascular transplants monitored with quantitative fluorometry. Plast Reconstr Surg, 1992, 90:105-111.
27.Jones BM,Dunscombe PB, Greenhalgh RM. Differential thermometry as a monitor of blood flow in skin flaps.Br J Plast Surg, 1983, 36:88-94.
28. Krupatkin AL. Surface temperature or tissue oxygen tension for monitoring of skin flaps? Plast Reconstr Surg,1993,92:370-371.
29. Raymond M, Dunn MD, Lvor B, Kaplan MD, et al. Experimental and clinical use of PH Monitoring of Free Tissue Transfers, Ann Plast Surg, 1993, 31(6):539-545.
30. Jones NF, Gupta R. Postoperative monitioring of pediatric toe-to hand transfers with differential pulse oximetry. J Hand Surg[AM], 2001, 26(3):476-480.
31.Mark C,Rocbat, DVM. Evaluation of skin viability in dogs, using transcutaneous carbon dioxide and sensor current monitoring. AM J vet Res, 1993, 54(3): 476-480.
32. Mahoney, JL, Lista FR Variations in flap blood flow tissue P02:A new technique for monitoring flap viability. Ann Plast Surg, 1988,20:43.
33. Hofer SOP,Timmenga EJF. An intravascular oxygen tension monitoring device nusedin myocutaneous btransplants:Apreliminary report.Microsurgery, 1003,14:304.
1.Schusterman,M.A.,Miller,M.J.,Reece,G.P,et al.A single center's experience with 308 free flaps for repair of head and neck cancer defects.Plast.Reconsrt.Surg.1994,93:472.
2.Kroll,S.S.,Schusterman,M.A.,Reece,G.P,et al.Choice of flap and incidence of free flaps success.Plast.Reconsrt.Surg,1996,98:459.
3.Hidalgo,D.A.,Disa,J.J.,Cordeiro,P.G.,et al.A review of 716 consecutive free flaps for oncologic surgical defects:Refinement in donor site selection and technique.Plast Reconstr.Surg,1998,102:722.
4.Kind,G.M,Buntic,R.F,Buncke,G.M.,et al.The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants.Plast.Reconsrt.Surg,1998.101:1268.
5.张选奋,郭树忠.皮瓣缺血坏死的药物防治研究进展[J].中华整形外科杂志.2002.18:240-243.
6.Cherry AE,George W,Pasyk K,et al.Increased survival and vascularity of random pattern skin flaps elevated in controlled,expanded skin.Plast Reconstr Surg,1983,73(50:680-685.
7.Baker JL.Occurrence and activity of my ofibroblasts in human capsular tissue surrounding mammary implant.Plast Reconstr Surg,1981,68(6):905-912.
8.刘志飞,乔群,王晓军等.联合应用扩张皮瓣延迟术和术前减张对提高扩张皮瓣血运的临床效果[J].中华医学美学美容杂志.2007,13(1):12-14.
9.郭杰,姜洪池,王淑杰.金属硫蛋白与皮瓣缺血预处理延迟保护作用的实验研究[J].中华整形外科杂志.2002,18:350-352.
10.郭恩覃主编.现代整形外科学[M].北京:人民军医出版社,2000,116.
11.李温仁,倪国坛主编.高压氧医学[M].上海:上海科学技术出版社,1998,358.
12.苏双意.高压氧治疗移植皮瓣血液循环障碍效果观察[J].护理学杂志.2002,17(4):273-274.
13.黄苏润.李小毅,张勇等.介绍一种皮瓣血液循环训练的新方法[J].中华烧伤杂志.2001,17(6):335.
14.Davis RE,Wachholz JH,Jassir D,et al.Comparison of topical anti-ischemic agents in the salvage of failing random-patterm skin flaps in rats.Arch Facial Plast Surg,1999,Jan-Mar,1(1):27-32.
15.栾杰,唐勇,张旭辉,等.外用罂粟碱霜对扩张皮肤血流量及扩张皮瓣成活长度的影响[J].实用美容整形外科杂志,2002,13(4):209-212.
16.Angel MF,Wanebo J,et al.The dorsal rat flap:a discussion of the model and the salutary effect of cimetidine on flap survival.Otolaryngol Head Neck Surg.1990 Nov,103(5):719-722.
17.Flameng K.Cardioprotective of idoflazine during 1 hour normothermic global ischemia Circulation,1981,64:796.
18.Kawabata H,Knight KR,et al.Experience with calcium antagonists nitrendipine,diltiazem,and verapamil and beta 2-agonist salbutamol in salvaging ischemic skin flaps in rabbits.Microsurgery.1991,12(3):160-163.
19.Weinstein GS,Maves MD,et al.Deferoxamine decreases necrosis in dorsally based pig skin flaps.Otolaryngol Head Neck Surg,1989,Nov,101(5):559-561.
20.毛运春等.氧自由基对肌皮瓣缺血再灌注损伤及维生素C对损伤的保护[J].中华整形烧伤外科杂志.1998,14(2):118-121.
21.Frick A,Baumeister RGH,Vollmer MB,et al.Sedondary ischemia in experimental free flap-treatment by long acting prostacycin analogues.Br J Plast Surg,1999,52:392-398.
22.Rajagopal U,Friedman RM,Robins JB,et al.Iloprost enhances survival of axial-pattern skin flaps in an ischemia-reperfusion model.Plast Reconstr Surg,1995,95:884-887.
23.Dolan RW,Kerr DC,et al.Reducing ischemia-reperfusion injury in rat island groin flaps by dexamethasone and BW755C.Laryngoscope.1995Dec,105(12);1322-1325.
24.Dolan RW,Kerr DC,et al.Improved reflow and viability in reperfused ischemic rat island groin flaps using dexamethasone.Microsurgery.1995.16(2):86-89.
25.Kleinschmidt K,Charles R,Pharmacology of low molecular weight heparins.Emerg Medclin North Am,2001,19:1025-1049.
26.Kirschner RE,Xu J,Fgfe B,et al.salarage of free flaps after secordary venous ischemia by local delivery of heparin.Am Plast Surg,1994,42:521-528.
27.王亚荣,何引飞,师润武,等.海普林对大鼠皮瓣成活影响的实验研究[J].中华整形外科杂志,2001,17:335-336.
28.Israel D,Zhang WX,Senderoff DM,et al.Use of urokinase duing secondary;schemia in experiment skin flaps.Am Plast Surg,1994,32:305-309.
29.Komorowska TE,Chen SG,Zhang F,et al.Prolonged perivascular use of verapamil or lidocaine decreases skin flap necrosis.Ann Plast Surg,1999,43:283-288.
30.蔚芃,李佛宝.血管内皮细胞生长因子影响大鼠皮瓣成活的实验研究[J].中国修得重建外科杂志.1997,11:376-378.
31.王绪凯,严冬,刘永权.碱性成纤维细胞生长因子对预构皮瓣血管化及成活的影响[J].中华整形外科杂志.2002,18:278-279.
2. Kroll, S .S., Schusterman, M .A., Reece, G .P, et al. Choice of flap and incidence of free flaps success.Plast.Reconsrt.Surg,1996, 98: 459.
3. Hidalgo, D.A., Disa, J.J., Cordeiro, P.G., et al. A review of 716 consecutive free flaps for oncologic surgical defects: Refinement in donor site selection and technique.Plast Reconstr.Surg,1998,102: 722.
4. Kind, G .M, Buntic, R .F, Buncke, G .M .,et al .The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants.Plast.Reconsrt. Surg,1998,101:1268.
5. Nichter LS, Sobieski MW, Edgerton MT. Efficacy of topical nitroglycerin for random-pattern skin-flap salvage, Plast Reconstr Surg, 1985, 75: 847-852.
6. James C .Yuen, M .D., and Zuliang Feng, M .D. Monitoring free flaps using the Laser Doppler flowmeter: five-year experience.Plast Reconsrt Surg,2000,105(1):55-61.
7. Hirigoyen, M .B., Urken, M .L., and Weinberg, H .Free flap monitoring: A review of current practice.Microsurgery,1995,16 :723.
8. Harrison DH, Girling M, Mott G. Methods of Assessing the viability of free flap transfer during the postoperative period. Clin Plast Surg 1983,10 : 21 -36.
9. Jones, M.D., Ranjan Gupta, M.D. Postoperative monitoring of pediatric toe-to-hand transfers with differential pulse oximetry. The Journal of Hand Surgery,2001, 26 (3): 525-529.
10. Angel, M.F., Mellow. C. G., Knight, K.R., and O'Brien, B.M. Secondary ischemia time in rodents: Contrasting complete pedicle interruption with venous obstruction.Plast. Reconsrt. Surg,1990, 85: 789
11. May JW, Chait LA, O'Brien BM, Hurley JV: The no-reflow phenomenon in experimental free flaps. Plast Reconstr Surg,1978, 61: 256.
12. Kerrigan CL, Daniel PK. Pharmacologic treatment of the failing skin flap. Plast Reconstr Surg, Nov 1982,70(5): 541-549.
13. Callegari PR, Taylor GI, Caddy CM, et al. An anatomic review of the delay phenomenon: I .Experimental studies. Plast Reconstr Surg, 1992, 89(3): 397-407.
14. Taylor GI, Corlett RJ, Caddy CM, et al. An anatomic review of the delay phenomenon: II. Clinical applications, Plast Reconstr Surg, 1992, 89(3): 408-416.
15. Forrest CR, Neligan P, Zhong A, et al. Acute adenosine treatment is effective in augmentation of ischemic tolerance in muscle flaps in the pig . Plast Reconstr Surg,Jan 1997, 99(1): 172-182.
16. Zahir KS, Syed SA, Zink JR,et al. Ischemic preconditioning improves the survival of skin and myocutaneous flaps in a rat model. Plast Reconstr Surg, Jul 1998,102(1):140-150.
17. Ishiguro N, Yabe Y, Shimizu T, et al. Basic fibroblast growth factor has a beneficial effect on the viability of random skin flaps in rats. Ann Plast Surg,1994,32(4): 356-360.
18. Wang BH, Ye C, Stagg CA, et al. Improved free musculocutaneous flap survival with induction of heat shock protein. Plast Reconstr Surg, 1998; 101(3): 776-784.
19. Schusterman MA, Miller MJ, Reece GP, et al. A single center's experience with 308 free flaps for repair of head and neck cancer defects. Plast Reconstr Surg 1994;93:472.
20. Kroll SS, Schusterman MA, Reece GP, et al.Chonice of flap and incidence of free flaps success. Plast Reconstr Surg 1996,98:459.
21. Hidalgo DA, Disa JJ, Cordeiro PG, et al. A review of 716 consecutive free flaps for oncologic surgical dedects: Refinement in donor site selection and technique.Plast Reconstr Surg 1998,102:722.
22. Kind GM, Buntic RF, Buncke GM, et al. The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants. Plast Reconstr Surg 1998,101:1268.
23. Jurell G, Hjemdahl P, Fredholm BB. On the mechanism by which antiadrenergic drugs increase survival of critical skin flaps. Plast Reconstr Surg 1983,72(4):518-525
24.Sastre N,Rodriguez A,Bias R.Skin flap neovascularization by means of a vasodilator.J Reconstr Microsurg 1987,3(3):265-268.
25.王培吉,王雅坤.应用罂粟碱和利多卡因预防和治疗微小血管吻合术后的血管痉挛[J].延边大学医学学报.2005,28(2):121-123.
26.王成琪,蒋纯志,张祚勇,等.植入型罂粟碱缓释剂在断指在植中的应用[J].中华显微外科杂志.1995,18(1):34-36.
27.张莉,李智贤,刘达恩,等.彩色多普勒超声显像应用于轴形皮瓣血管的检测[J].实用医学影像杂志.2005,6(1):36-38.
28.Fitzal F,Valentini D,Worseg A,et al.Evaluation of total vs.regional blood perfusion with a laser Doppler imaging system in the rat epigastric flap.J Reconstr Microgurg 2001,17(1):59-62.
29.Yuen JC,Feng Z.Disitinguuishing laser Doppler flowmetric responses between arterial and venous obstructions in flaps.J Reconstr Microsurg 2000,16(8):629-635.
30.Yuen JC,Feng Z.Monitoring ree flaps using the laser Doppler flowmeter:five-year experience.Plast Reconstr Surg 2000,105(1):55-61.
31.James L.Variations in flap blood flow and tissue PO2:A new technique for monitoring flap viability.Annals of Plastic Surgery,1988,20(1):43-47.
32.Achauer BM,Black KS,Litke DK:Transcutaneous po2 in flaps:a new method of survival prediction.Plast Reconstr Surg 1980,65:738.
33.Svedman,P.,Jacobsson,S.,Ponnert,L.,and Lindell,S.E.Transcutaneous oxygen tension in flaps.Chir.Plast,1982,6:201.
34.王宏图,张静华.新编药物临床手册[M].上海:上海医科大学出版社,1998:211.
35.Wilen G.Metabolism of 14C Papaverine in man.Jpharm Pharmacol,1982,34:264-268.
36.Maggi GC.Papaverine blood levels after administration of a sustained release preparation.Arzneinr Forsch/Drug Res.1997,27:1214-1219.
37.陈新谦,金有豫,汤光.新编药物手册[M].15版.北京:人民卫生出版社,2003:360.
38.彭司勋.药物化学.北京:化学工业出版社,1988:167.
39.刘芳龄,刘多三,饶明俐,等.尼莫地平和罂粟碱对实验性迟发性脑血管痉挛的作用[J].中华医学杂志.1996,76(2):132-134.
40.张跃伟,黄正松,五光伟,等.内皮素在血管内治疗迟发性脑血管痉挛前后含量变化的实验研究[J].临床放射性杂志.2004,20(7):536-538.
41.贺道华,马廉亭.罂粟碱、尼莫同治疗脑血管痉挛的疗效比较[J].暨南大学学报(自然科学版).2002,21(1):105-108.
42.芦奕,孙丕通,惠国桢,等.动脉持续灌注罂粟碱对兔脑血管痉挛的实验研究[J].江苏医药杂志.2004,30(5):334-337.
43.蒋栋毅,周岱.动脉内灌注罂粟碱治疗脑血管痉挛的实验研究[J].苏州医学院学报.2001,21(6):621-624.
44.郑毅,万峰,陈或,等.不同血管保存液对人桡动脉血管移植物的抗痉挛作用[J].中华实验外科学杂志.2004,21(8):1005-1006.
45.周金良,黄胜平.尼莫同、罂粟碱术野灌洗治疗侧裂入路术中血管痉挛效果比较[J].南通医学院学报.2004,24(3):341-342.
46.栾杰,唐勇,张旭辉,等.外用罂粟碱霜对扩张皮肤血流量及扩张皮瓣成活长度的影响[J].实用美容整形外科杂志.2002,13(4):209-212.
47.李景文,龙村,高国栋.尼可地尔及罂粟碱对冠状动脉旁路移植术大隐静脉血管桥血管舒张功能的影响[J].中国体外循环杂志.2005,3(3):164-166.
48.Lee P,Squier CA,Bardach J.Enhancement of tissue expansion by anticontractile agents[J].Plast Reconstr Surg,1985,76(4):604.
49.Matt BH,Squire CA Kelly KM,etal.Enhancement of expansion of guinea pigskin by local delivery of an anticontractile agent using a new bilumen expander[J].Ann Plast surg,1990,24(4):335.
50.吴钟琪,周宏灏,许树格.全科医学临床药物学.北京:科学出版社,1998:119.
51.范启申,王成琪.现代骨科显微手术学[M].北京:人民军医出版社,1995:25
52.王立峰,岳学军,智江.盐酸罂粟碱在断指再植中的应用体会[J].中国交通医学杂志.2005,19(2):140
53.Jurell G,Hjemdahl P,Fredholm BB.On the mechanism by which antiadrenergic drugs increase survival of critical skin flaps.Plast Reconstr Surg 1983,72(4):518-525
54.Sastre N,Rodriguez A,Blas R.Skin flap neovascularization by means of a vasodilator.J Reconstr Microsurg 1987,3(3):265-268.
55.Kroll,S.S.,Schusterman,M.A.,Reece,G.P.,et al.Choice of flap and incidence of free flaps success.Plast.Reconstr.Surg,1996,98:459.
56.Hidalgo,D.A.,Disa
58.Hirigoyen MB,Urken ML,Weinberg H.Free flap monitoring:a review of current practice.Microsurgery,1995,16:723-727.
59.James L.Variations in flap blood flow and tissue PO2:A new technique for monitoring flap viability.Annals of Plastic Surgery,1988,20(1):43-47.
60.张莉,李智贤.超声影像检测轴型皮瓣血供的研究进展[G].2004全国医学影像技术学术会议论文汇编.2004:301-304.
61.Clouston JE,Numaguchi Y,Zoarski GH,et al.Intraarterial papaverine infusion for cerebral vasospasm after subarachnoid hemorrhage.AJNR Am J Neuroradiol 1995;16(1):27-38
62.Kaku Y,Yonekawa Y,Tsukahara T,et al.Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage.J Neurosurg 1992;77(6):842-847
63.王成琪,陈中伟,朱盛修.实用显微外科学[M].北京:人民卫生出版社.1992,104-105.
64.朱盛修,卢世壁.骨科显微手术学[M].北京:科学出版社.1983,48-49.
1. Schusterman, M .A., Miller, M J., Reece, G .P, et al .A single center's experience with 308 free flaps for repair of head and neck cancer defects.Plast.Reconsrt.Surg.1994, 93: 472.
2. Kroll, S .S., Schusterman, M .A., Reece, G .P, et al. Choice of flap and incidence of free flaps success.Plast.Reconsrt.Surg,1996, 98: 459.
3. Hidalgo, D.A., Disa, J.J., Cordeiro, P.G., et al. A review of 716 consecutive free flaps for oncologic surgical defects: Refinement in donor site selection and technique.Plast Reconstr.Surg,1998,102: 722.
4. Kind, G .M, Buntic, R .F, Buncke, G .M .,et al .The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants.Plast.Reconsrt. Surg,1998,101:1268.
5. Nichter LS, Sobieski MW, Edgerton MT. Efficacy of topical nitroglycerin for random-pattern skin-flap salvage, Plast Reconstr Surg, 1985, 75: 847-852.
6. James C .Yuen, M .D., and Zuliang Feng, M .D. Monitoring free flaps using the Laser Doppler flowmeter: five-year experience.Plast Reconsrt Surg,2000,105(1):55-61.
7. Hirigoyen, M .B., Urken, M .L., and Weinberg, H .Free flap monitoring: A review of current practice.Microsurgery,1995,16 :723.
8.Harrison DH,Girling M,Mott G.Methods of Assessing the viability of free flap transfer during the postoperative period.Clin Plast Surg 1983,10:21-36.
9.Jones,M.D.,Ranjan Gupta,M.D.Postoperative monitoring of pediatric toe-to-hand transfers with differential pulse oximetry.The Journal of Hand Surgery,2001,26(3):525-529.
10.Angel,M.F.,Mellow.C.G.,Knight,K.R.,and O'Brien,B.M.Secondary ischemia time in rodents:Contrasting complete pedicle interruption with venous obstruction.Plast.Reconsrt.Surg,1990,85:789
11.May JW,Chait LA,O'Brien BM,Hurley JV:The no-reflow phenomenon in experimental free flaps.Plast Reconstr Surg,1978,61:256.
12.Kroll,S.S.,Schusterman,M.A.,Reece,G.P.,et al.Choice of flap and incidence of free flaps success.Plast.Reconstr.Surg,1996,98:459.
13.Hidalgo,D.A.,Disa
15.谢汉波,平祖衡,鲍同柱.彩色多普勒探查在带血管蒂皮瓣移植术的应用[J].中国超声医学杂志.1997,13(11):62-64.
16.张莉,李智贤,刘达恩等.不同类型血供轴型皮瓣轴心动脉超声显像的探讨 [J]. 中国超声医学杂志. 2006,22(1):58-60
17. Jone BM, Mayou BJ. The laser Dopple flowmete for microvascular monitoring. A preliminary report.Br J plast surg, 1982,35:147-149.
18. Heller, Levin LS, Klitzman B. Laser Doppler flowmete monitoring of free tissue transfers: blood flow in normal and complicated cases. Plast Reconstr Surg, 2001, 107(7):1739-1745.
18. Yuen JC, feng Z. Distinguishing laster Doppler flowmetric responses between arterial and venous obstructions in flaps. J Reconstr Microsurg,200,16(8):629-635.
19. Stone CA, Dubbins PA, Morris RJ.Use of cocor duplex Doppler imaging in the postoperative assessment of buried free flaps.Microsurgery, 2001, 21 (5):223-227.
20. Dooley TW, Welsh DF, Puckett CL.Noninvasive assessment of microvessels with the duplex scanner. J Hand surg, 1989,14A:670-673.
21. Gurunluoglu R,Bayramicli M, Sonmez A, Numanoglu A. A neurocutaneous island flap model: an experimental study in rats. Ann Plast Surg, 2000, 44(1):53-58.
22. Erisson E, Heden P. Method for skin blood flow studies in the pig.Scand J plast reconstr surg, 1988,22:229-232.
23. Cordeiro PG, santamaria E, Hu QY, et al.The timing and nature of
neovascularization of jejunal free flaps:an experimental study in a large animal model. Plast Reconstr Surg, 1999,103(7):1893-1901. 24.Yucel A, Bayramicli M. Effects of hyperbaric oxygen treatment and heparin on the survival of unipedicled venous flaps:an experimental study in rats. Ann Plast Surg,2000, 44(3):295-303.
25. Ergun H, Cilingir MG, Apaydin I, et al. The effect of dipyrone on survival of skin flaps. Scand J Plast Reconstr Surg Hand Surg, 2001, 35(1):19-22.
26. Whitney TM, Lineaweaver WC, Billys JB, et al. Improved salvage of complicated microvascular transplants monitored with quantitative fluorometry. Plast Reconstr Surg, 1992, 90:105-111.
27.Jones BM,Dunscombe PB, Greenhalgh RM. Differential thermometry as a monitor of blood flow in skin flaps.Br J Plast Surg, 1983, 36:88-94.
28. Krupatkin AL. Surface temperature or tissue oxygen tension for monitoring of skin flaps? Plast Reconstr Surg,1993,92:370-371.
29. Raymond M, Dunn MD, Lvor B, Kaplan MD, et al. Experimental and clinical use of PH Monitoring of Free Tissue Transfers, Ann Plast Surg, 1993, 31(6):539-545.
30. Jones NF, Gupta R. Postoperative monitioring of pediatric toe-to hand transfers with differential pulse oximetry. J Hand Surg[AM], 2001, 26(3):476-480.
31.Mark C,Rocbat, DVM. Evaluation of skin viability in dogs, using transcutaneous carbon dioxide and sensor current monitoring. AM J vet Res, 1993, 54(3): 476-480.
32. Mahoney, JL, Lista FR Variations in flap blood flow tissue P02:A new technique for monitoring flap viability. Ann Plast Surg, 1988,20:43.
33. Hofer SOP,Timmenga EJF. An intravascular oxygen tension monitoring device nusedin myocutaneous btransplants:Apreliminary report.Microsurgery, 1003,14:304.
1.Schusterman,M.A.,Miller,M.J.,Reece,G.P,et al.A single center's experience with 308 free flaps for repair of head and neck cancer defects.Plast.Reconsrt.Surg.1994,93:472.
2.Kroll,S.S.,Schusterman,M.A.,Reece,G.P,et al.Choice of flap and incidence of free flaps success.Plast.Reconsrt.Surg,1996,98:459.
3.Hidalgo,D.A.,Disa,J.J.,Cordeiro,P.G.,et al.A review of 716 consecutive free flaps for oncologic surgical defects:Refinement in donor site selection and technique.Plast Reconstr.Surg,1998,102:722.
4.Kind,G.M,Buntic,R.F,Buncke,G.M.,et al.The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants.Plast.Reconsrt.Surg,1998.101:1268.
5.张选奋,郭树忠.皮瓣缺血坏死的药物防治研究进展[J].中华整形外科杂志.2002.18:240-243.
6.Cherry AE,George W,Pasyk K,et al.Increased survival and vascularity of random pattern skin flaps elevated in controlled,expanded skin.Plast Reconstr Surg,1983,73(50:680-685.
7.Baker JL.Occurrence and activity of my ofibroblasts in human capsular tissue surrounding mammary implant.Plast Reconstr Surg,1981,68(6):905-912.
8.刘志飞,乔群,王晓军等.联合应用扩张皮瓣延迟术和术前减张对提高扩张皮瓣血运的临床效果[J].中华医学美学美容杂志.2007,13(1):12-14.
9.郭杰,姜洪池,王淑杰.金属硫蛋白与皮瓣缺血预处理延迟保护作用的实验研究[J].中华整形外科杂志.2002,18:350-352.
10.郭恩覃主编.现代整形外科学[M].北京:人民军医出版社,2000,116.
11.李温仁,倪国坛主编.高压氧医学[M].上海:上海科学技术出版社,1998,358.
12.苏双意.高压氧治疗移植皮瓣血液循环障碍效果观察[J].护理学杂志.2002,17(4):273-274.
13.黄苏润.李小毅,张勇等.介绍一种皮瓣血液循环训练的新方法[J].中华烧伤杂志.2001,17(6):335.
14.Davis RE,Wachholz JH,Jassir D,et al.Comparison of topical anti-ischemic agents in the salvage of failing random-patterm skin flaps in rats.Arch Facial Plast Surg,1999,Jan-Mar,1(1):27-32.
15.栾杰,唐勇,张旭辉,等.外用罂粟碱霜对扩张皮肤血流量及扩张皮瓣成活长度的影响[J].实用美容整形外科杂志,2002,13(4):209-212.
16.Angel MF,Wanebo J,et al.The dorsal rat flap:a discussion of the model and the salutary effect of cimetidine on flap survival.Otolaryngol Head Neck Surg.1990 Nov,103(5):719-722.
17.Flameng K.Cardioprotective of idoflazine during 1 hour normothermic global ischemia Circulation,1981,64:796.
18.Kawabata H,Knight KR,et al.Experience with calcium antagonists nitrendipine,diltiazem,and verapamil and beta 2-agonist salbutamol in salvaging ischemic skin flaps in rabbits.Microsurgery.1991,12(3):160-163.
19.Weinstein GS,Maves MD,et al.Deferoxamine decreases necrosis in dorsally based pig skin flaps.Otolaryngol Head Neck Surg,1989,Nov,101(5):559-561.
20.毛运春等.氧自由基对肌皮瓣缺血再灌注损伤及维生素C对损伤的保护[J].中华整形烧伤外科杂志.1998,14(2):118-121.
21.Frick A,Baumeister RGH,Vollmer MB,et al.Sedondary ischemia in experimental free flap-treatment by long acting prostacycin analogues.Br J Plast Surg,1999,52:392-398.
22.Rajagopal U,Friedman RM,Robins JB,et al.Iloprost enhances survival of axial-pattern skin flaps in an ischemia-reperfusion model.Plast Reconstr Surg,1995,95:884-887.
23.Dolan RW,Kerr DC,et al.Reducing ischemia-reperfusion injury in rat island groin flaps by dexamethasone and BW755C.Laryngoscope.1995Dec,105(12);1322-1325.
24.Dolan RW,Kerr DC,et al.Improved reflow and viability in reperfused ischemic rat island groin flaps using dexamethasone.Microsurgery.1995.16(2):86-89.
25.Kleinschmidt K,Charles R,Pharmacology of low molecular weight heparins.Emerg Medclin North Am,2001,19:1025-1049.
26.Kirschner RE,Xu J,Fgfe B,et al.salarage of free flaps after secordary venous ischemia by local delivery of heparin.Am Plast Surg,1994,42:521-528.
27.王亚荣,何引飞,师润武,等.海普林对大鼠皮瓣成活影响的实验研究[J].中华整形外科杂志,2001,17:335-336.
28.Israel D,Zhang WX,Senderoff DM,et al.Use of urokinase duing secondary;schemia in experiment skin flaps.Am Plast Surg,1994,32:305-309.
29.Komorowska TE,Chen SG,Zhang F,et al.Prolonged perivascular use of verapamil or lidocaine decreases skin flap necrosis.Ann Plast Surg,1999,43:283-288.
30.蔚芃,李佛宝.血管内皮细胞生长因子影响大鼠皮瓣成活的实验研究[J].中国修得重建外科杂志.1997,11:376-378.
31.王绪凯,严冬,刘永权.碱性成纤维细胞生长因子对预构皮瓣血管化及成活的影响[J].中华整形外科杂志.2002,18:278-279.