课题背景：国内外在缺血预处理或药物预处理等方面作了大量工作，但因后期疗效差或费用昂贵等原因，均难于广泛用于临床。因此，寻求一种便捷有效的治疗手段以保证尽早恢复缺血组织血流的同时减轻或防止缺血再灌注损伤,是其防治中亟待解决的重要课题。

应用要点：目前国内外关于高压氧治疗脑外伤、断肢再植等领域报道较多，将其应用于肢体缺血再灌注损伤的治疗尚较少见；本实验应用高压氧作用于大鼠不同时相的缺血再灌注肢体，证实其有效抑制了炎症因子激活释放，促进了纤溶系统激活，对缺血再灌注肢体的结构功能产生了较显著的保护作用。

同行评价：实验着眼于高压氧对大鼠不同时相肢体缺血再灌注所造成的炎症反应、凝血激活及组织形态学改变等方面的影响，以期证实高压氧对肢体缺血再灌注损伤的保护作用。文章有一定科学性，内容较新颖。

摘要
背景：近年有学者提出高压氧对缺血再灌注损伤氧自由基的清除有正性作用，并能提高三磷酸腺苷合酶的活性，调节钠钙平衡，抑制钙内流，从而有效保护细胞，减轻缺血再灌注损伤。
目的：从骨骼肌的病理和细胞因子改变角度，观察高压氧对不同时相肢体缺血再灌注的影响。
设计、时间及地点：随机对照动物实验，于2007-04/09在重庆医科大学实验动物中心完成。
材料：健康SD大鼠108只，体质量250~300 g。随机分为空白对照组12只、缺血再灌注组48只与高压氧组48只，雌雄对等。
方法：空白对照组不做缺血再灌注；缺血再灌注组和高压氧组持续缺血8 h，分别行再灌注0，4，24，72 h。高压氧组造模后连续5 d给予高压氧处理。
主要观察指标：检测各组大鼠组织萃取液中白细胞介素1、 白细胞介素6、 白细胞介素8、组织纤溶酶原激活物、组织纤溶酶原激活物抑制剂1含量；以大鼠腓肠肌制备电镜和光镜标本，观察其骨骼肌微血管超微结构和组织形态变化；
结果：①再灌注后各个时点，高压氧组组织纤溶酶原激活物含量较缺血再灌注组均显著升高；白细胞介素1、白细胞介素6、白细胞介素8、组织纤溶酶原激活物抑制剂1含量较缺血再灌注组均显著降低(P < 0.05)。②再灌注24 h，与缺血再灌注组比较，高压氧治疗组骨骼肌细胞肿胀及炎性细胞浸润均较轻，微血管内几乎无微血栓形成，肌小节极少断裂，质膜较少破坏，少数线粒体肿胀，髓样结构形成。
结论：损伤后72 h之内高压氧对缺血再灌注肢体产生了较显著的保护作用，该作用可能与抑制炎症因子激活释放，促进纤溶系统激活有关。
关键词：再灌注损伤；细胞因子；高压氧；组织构建

高博，任为，张彦，宋红，汪永强，雷燕，赵渝. 大鼠缺血再灌注损伤肢体骨骼肌形态和组织中细胞因子变化及高压氧的干预[J].中国组织工程研究与临床康复，2008，12(20):3874-3878 [www.zglckf.com/zglckf/ejournal/upfiles/08-20/20k-3874(ps).pdf]

Abstract
BACKGROUND:Hyperbaric oxygen has positive effects on clearance of oxygen free radical following ischemia/reperfusion injury, increases adenosine triphosphate synthase activity, regulates natrium-calcium balance, inhibits calcium influx, resulting in effectively protecting cells and relieving ischemia/reperfusion injury.
OBJECTIVE: To investigate the effects of hyperbaric oxygen on the limb ischemia/reperfusion at different phases from the angle of pathology and cytokine of the skeletal muscle.
DESIGN, TIME AND SETTING: Randomized controlled animal experiments were performed at the Laboratory Animal Center of Chongqing Medical University from April to September 2007.
MATERIALS: 108 healthy SD rats weighing 250-300 g (male or female equally) were randomly divided into a blank control group (n=12), an ischemia/reperfusion group (n=48) and a hyperbaric oxygen group (n=48).
METHODS: Rats in the blank control group did not treat by ischemia/reperfusion injury. Rats in the ischemia/reperfusion group and the hyperbaric oxygen group underwent different phases of reperfusion including 0, 4, 24 and 72 hours after 8 hours of sustained ischemia. Rats in the hyperbaric oxygen group were treated with hyperbaric oxygen for 5 days.
MAIN OUTCOME MEASURES: Interleukin 1, interleukin 6, interleukin 8, plasminogen activator inhibitor 1, and tissue plasminogen activator levels were measured in protein extracts for each experimental interval. Electron microscope and light microscope were used to observe the ultramicrostructure and morphology changes in the skeletal muscle and capillary of rat gastroenemius.
RESULTS: In hyperbaric oxygen group, tissue plasminogen activator levels significantly increased compared with the ischemia/reperfusion group. Interleukin 1, interleukin 6, interleukin 8 and plasminogen activator inhibitor 1 levels in various time points significantly decreased compared with the ischemia/reperfusion group (P < 0.05). Compared with the ischemia/reperfusion group, the cellular swelling of skeletal muscle and the local cytokine response were significantly lower, almost without microvascular thrombosis in capillary vessel; The sarcomere was rarely collapsed, little plasma membrane was shattered, little mitochondrial swelled or formatted the myelinfigure in the hyperbaric oxygen group 24 hours after reperfusion.
CONCLUSION: Hyperbaric oxygen had a more significant protective effect on limb ischemia and reperfusion within 72 hours following injury. This effect is associated with inhibition of inflammatory factor activation and release as well as promotion of fibrinolytic system activation.

Gao B, Ren W, Zhang Y, Song H, Wang YQ, Lei Y, Zhao Y. Hyperbaric oxygen effects on the cytokines and morphological changes of the skeletal muscle in rats following ischemia/reperfusion injury.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(20): 3874-3878(China) [www.zglckf.com/zglckf/ejournal/upfiles/08-20/20k-3874(ps).pdf]