目的验证血管内应用透明质酸酶(Hyaluronidase,HAase)治疗透明质酸(Hyaluronid acid,HA)动脉栓塞兔耳皮肤缺血性病变的效果,比较全身静脉溶栓和选择性动脉溶栓的疗效差异。方法新西兰大白兔25只,经耳郭后动脉注射20μL HA,制作单耳动脉栓塞皮肤缺血模型,分为5组(n=5):单纯栓塞对照组(Control组)、生理盐水静脉溶栓对照组(IVT-NaCl组)、HAase静脉溶栓治疗组(IVT-HAase组)、生理盐水选择性动脉溶栓对照组(IAT-NaCl组)、HAase选择性动脉溶栓治疗组(IAT-HAase组)。术后4 h、3 d、7 d行荧光造影检查。比较各组术后7 d皮瓣灌注面积差异。结果术后7 d时,IAT-HAase组皮瓣平均灌注面积百分比显著高于其他4组(_P0.05)。结论 HAase选择性动脉溶栓能够有效改善HA动脉栓塞引起的皮瓣缺血,增加组织灌注,缩小皮瓣坏死面积。HAase全身静脉溶栓的疗效有待进一步研究。

Objective To explore the effect of intravascular hyaluronidase(HAase) in treating rabbit auricular skin flap ischemia caused by HA induced artery embolism, and to compare the different effect of intravenous thrombolysis and selective intra-arterial thrombolysis with HAase. Methods The auricular skin flap model of 20 μL HA artery emblism were created in twenty-five rabbits and the rabbits were divided into five groups(n=5). Control group: no treatment; IVT-NaCl group: intravenous thrombolysis with saline; IVT-HAase group: intravenous thrombolysis with HAase; IAT-NaCl group:intra-arterial thrombolysis with saline; IAT-HAase group: intra-arterial thrombolysis with HAase. Fluorescein examination was performed 4 hours, 3 days and 7 days after operation. The difference of the area percentage of flap perfusion in the five groups was compared 7 days after operation. Results The mean area percentage of flap perfusion of IAT-HAase group was significantly higher than that in the other four groups(P 0.05). Conclusion The selective intra-arterial thrombolysis with HAase can effectively improve the ischemia of the flap caused by HA induced artery embolism, increase the tissue perfusion, and reduce the necrotic area of the flap. However, the effect of intravenous use of HAase as thrombolytic agent needs further investigation.