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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2022, Vol. 10 ›› Issue (02) : 162 -168. doi: 10.3877/cma.j.issn.2095-5782.2022.02.008

基础研究

经导管动脉溶栓治疗严重冻伤的基础研究
付金鑫1, 段峰1, 张金龙2, 袁冰1, 张恒1, 阎洁羽1, 管阳1, 王燕1, 袁凯1, 王茂强1,†()   
  1. 1. 100853　北京，中国人民解放军总医院介入放射科
    2. 100730　北京，首都医科大学附属北京同仁医院　放射科
  • 收稿日期:2022-03-03 出版日期:2022-05-25
  • 通信作者: 王茂强

The basic study of transcatheter intra-arterial thrombolysis in the treatment of severe frostbite

Jinxin Fu1, Feng Duan1, Jinlong Zhang2, Bing Yuan1, Heng Zhang1, Jieyu Yan1, Yang Guan1, Yan Wang1, Kai Yuan1, Maoqiang Wang1,†()   

  1. 1. Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853
    2. Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Bejing 100730, China
  • Received:2022-03-03 Published:2022-05-25
  • Corresponding author: Maoqiang Wang
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付金鑫, 段峰, 张金龙, 袁冰, 张恒, 阎洁羽, 管阳, 王燕, 袁凯, 王茂强. 经导管动脉溶栓治疗严重冻伤的基础研究[J]. 中华介入放射学电子杂志, 2022, 10(02): 162-168.

Jinxin Fu, Feng Duan, Jinlong Zhang, Bing Yuan, Heng Zhang, Jieyu Yan, Yang Guan, Yan Wang, Kai Yuan, Maoqiang Wang. The basic study of transcatheter intra-arterial thrombolysis in the treatment of severe frostbite[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2022, 10(02): 162-168.

目的

探究经导管动脉灌注复方丹参注射液治疗新西兰白兔严重冻伤模型的有效性及机制。

方法

36只新西兰白兔的严重冻伤模型随机分成3组，A组：常规溶栓组（t-PA +肝素+罂粟碱）；B组：改良溶栓组（t-PA +肝素+罂粟碱+复方丹参注射液）；C组：对照组（生理盐水），各组均于溶栓后24 h进行患肢动脉造影并评估应答，进行血常规、凝血及纤溶活性指标、血栓素B2、6-酮-前列腺F_1α、丙二醛、超氧化物歧化酶检测并进行组间比较。每组剩余2只模型行受累肢端组织病理学检查。采用截趾率和得分法进行统计最终截肢率并进行组间比较。

结果

A、B、C组模型的血管造影应答中完全缓解分别为3、0、0例，大部分缓解分别为4、2、0例，轻度缓解分别为2、4、2例，无缓解分别为1、4、8例。各组间模型WBC数量比较具有显著性差异（P值均< 0.05）；RBC、HGB、HCT比较无显著性差异（P值均> 0.05）；A、B组模型的血小板数量明显高于C组（P值均< 0.05）；A、B组模型的PT、APTT显著地长于C组（P值均< 0.05）；A、B组模型的FIB显著地低于C组（P值均< 0.05）；B组模型的血浆6-酮-前列腺F_1α、超氧化物歧化酶含量显著地高于A和C组（P值均< 0.05）；B组模型的血浆血栓素B2、丙二醛含量显著地低于A和C组（P值均< 0.05），A、B、C组模型截趾率分别为46.9%、22.5%、85.0%，得分法分别为9.5 ± 2.7、4.3 ± 1.1、21.8 ± 4.2；各组间模型截趾率及得分比较均有显著性差异（P值均< 0.05）。

结论

复方丹参注射液可显著降低新西兰白兔严重模型的截趾率，可能的机制是复方丹参注射液可纠正严重冻伤后机体的PGI2-TXA2及氧化-抗氧化失衡。

关键词: 冻伤, 动脉内灌注, 溶栓治疗, 血管造影术
Objective

To explore the efficacy and mechanism of transcatheter arterial compound Danshen injection infusion in the treatment of severe frostbite in New Zealand white rabbits.

Methods

36 New Zealand white rabbits with severe frostbite underwent routine rewarming and were randomly divided into 3 groups, Group A: conventional thrombolytic group (t-PA + heparin + papaverine), B Group: modified thrombolytic group (t-PA + heparin + papaverine + compound Danshen injection), group C: control group (normal saline). Severe frostbite model of 10 New Zealand white rabbits in each group were assessed by angiographic response 24 hours after thrombolytic therapy. Blood routine, coagulation and fibrinolytic activity indicators, TXB2, 6-keto-PGF1α , MDA, SOD were measured and compared between groups.The remaining 2 rabbits in each group were performed histopathological examination, the final amputation was analyzed by toe amputation rate and scoring method and compared between groups.

Results

Complete response in angiographic assessment in group A, B and C occured in 3, 0, 0 cases, majority response in 4, 2, 0 cases, mild response in 2, 4, 2 cases, no response in 1, 4, 8 cases. There was significant difference in the number of WBCs among all groups after thrombolytic therapy (P < 0.05). There was no significant difference in RBC, HGB and HCT (P > 0.05). The number of platelets in group A and group B was significantly higher than that in group C (P < 0.05). PT and APTT in group A and group B were significantly longer than those in group C (P < 0.05). FIB in group A and group B was significantly lower than that in group C (P < 0.05). The levels of plasma 6-keto-PGF1α and SOD in group B were significantly higher than those in group A and C (P < 0.05). The levels of TXB2 and MDA in group B were significantly lower than those in group A and C (P < 0.05). The toes amputation rates of group A, B and C were 46.9%, 22.5% and 85.0% respectively. The results of scoring method were 9.5 ± 2.7, 4.3 ± 1.1 and 21.8 ± 4.2 respectively. There were significant differences in amputation rate and score among all groups (P < 0.05).

Conclusions

Compound Danshen injection can significantly reduce the rate of toe amputation in severely frostbitten rabbits, the possible mechanism may be that compound Danshen injection can correct the PGI2-TXA2 and oxidation-antioxidation imbalance.

Key words: Frostbite, Intra-arterial infusion, Thrombolysis, Angiography
图1 新西兰白兔指（趾）端及关节平面的截肢分数定义
图2 A组模型溶栓治疗后血管造影图像及最终肢端坏死情况，溶栓治疗后血管造影提示轻度缓解（竖箭头），最终坏死范围为第二趾骨近端平面（横箭头）。
图3 B组模型溶栓治疗后血管造影图像及最终肢端坏死情况，溶栓治疗后血管造影提示大部分缓解，仅第一、二趾端末血管充盈缺损（竖箭头），最终坏死范围为第一、二趾端末端（横箭头）。
图4 C组模型生理盐水灌注后血管造影图像及最终肢端坏死情况，生理盐水灌注后血管造影提示无缓解（竖箭头），最终坏死范围为第四趾端远端平面（横箭头）。
图5 3组模型溶栓治疗后左前肢端血管病理图像5A：A组模型溶栓治疗后左前肢端血管病理图像提示血管再通，未见血栓（箭头）。5B：B组模型溶栓治疗后左前肢端血管病理图像提示血管再通，未见血栓（箭头）。5C：C组模型生理盐水灌注后左前肢端血管病理图像提示血管内可见混合血栓（箭头），周围组织伴有坏死，坏死细胞核固缩或碎裂，结构基本丧失。
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