课题背景：带血管游离皮瓣移植是修复创伤组织缺损最有效的方法，但吻合口及附近的一段血管极易发生痉挛，导致移植失败。临床上常用罂粟碱等血管舒张药预防和处理有关并发症，给药途径主要有臀部肌肉注射和静脉注射，皮瓣局部应用扩血管药物尚未常规采用，其效果如何？课题正是基于这一情况设计立项。

应用要点：文章观察在带血管蒂皮瓣自体移植中定量罂粟碱（1.5 mg/kg）不同给药途径对移植皮瓣血管阻力的影响，以期寻找一种最佳的给药途径，提高皮瓣自体移植成活率。结果证实在皮瓣中央进行罂粟碱皮下注射效果最佳，具有较大的临床实用价值。

同行评价：文章探讨在带血管蒂皮瓣移植中，定量罂粟碱的4种给药途径对皮瓣移植后血管阻力的影响，结果证实在皮瓣中央进行罂粟碱皮下注射效果最佳，选题较新颖，实验手段较先进。

摘要
目的: 临床上常用罂粟碱等血管舒张药预防和解除带血管蒂游离皮瓣移植吻合口及其附近血管痉挛，减少血管阻力，提高皮瓣成活率。观察在带血管蒂皮瓣移植中，定量罂粟碱（1.5 mg/kg）的不同给药途径对皮瓣移植后血管阻力的影响。
方法：①实验于2007-03/05在广州市第一人民医院动物实验中心完成。②选用雄性新西兰兔24只，实验方法符合动物伦理学要求。采用随机区组设计，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、臀部肌肉注射组及对照组（静脉推注）。建立下腹部腹壁浅动脉皮瓣模型，术后1 h~7 d每组定量注射罂粟碱，剂量为1.5 mg/kg，1次/d。③利用彩色多普勒超声测量术前、术后1周内每天注药后1 h的皮瓣血流阻力指数。
结果：24只兔全部进入结果分析。①术后各组移植皮瓣的血流阻力指数均高于术前（P < 0.05）。②术后第1天注药后1 h皮瓣中央皮下注射组的血流阻力指数低于臀部肌肉注射组（P < 0.01），与其他两组差异无显著性意义（P > 0.05）。术后第4天注药后1 h皮瓣中央皮下注射组的血流阻力指数低于其他3 组（P < 0.05）。术后第5天注药后1 h除臀部肌肉注射组血流阻力指数略高于手术前外，其他各组的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）。
结论：皮瓣移植术后经皮瓣中央皮下注射罂粟碱扩血管效果最好，能改善皮瓣的成活能力；静脉注射与皮瓣蒂部皮下注射效果相近；臀部肌肉注射效果最差。
关键词：皮肤移植；罂粟碱；血管阻力

陈庆亮，王钢，资青兰，何景光，陈秀虎，温世锋，杨运发，柳建华.定量罂粟碱不同给药途径对移植皮瓣血管阻力的影响[J].中国组织工程研究与临床康复，2008，12(5):868-871 [www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-868(ps).pdf]

Influence of quantified papaverine by different injection approaches on peripheral resistance of grafting skin flaps

Abstract

AIM：Vasodilatator such as papaverine is frequently used to prevent and relieve vasospasm of grafting pedicle free flap stoma, reduce vascular resistance and increase flap survival rate. This study observed the influence of quantified papaverine (1.5 mg/kg) with different administration pathway on peripheral resistance in grafting skin flap.
METHODS: ①The experiment was performed at Animal Experimental Center of Guangzhou First People's Hospital from March to May 2007. ②Twenty-four male New Zealand rabbits were selected and randomized into 4 groups (n=6): skin flap pedicle subcutaneous injection group, skin flap center subcutaneous injection group, intramuscular injection group, and control group (intravenous injection). The experimental procedure was accorded with animal ethical standards. Bilateral 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 flap blood flow was observed by color Doppler ultrasound before operation, and one hour after injection within one week after operation.
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 resistance index of flap blood flow in skin flap center group one hour after injection on the first day after operation was significantly lower than that in intramuscular injection group (P < 0.01), but no difference was found compared with the other two groups (P > 0.05). One hour after injection on the fourth day, the resistance index of skin flap center group was significantly lower than the other groups (P < 0.05). One hour after injection on the fifth day, the resistance index of intramuscular injection group was higher compared with before operation, but the other groups were lower than before operation. There was no significant difference among 3 groups (P > 0.05).
CONCLUSION: After flap grafting, papaverine injection in skin flap center achieves the best effect and improves flap survival. Intravenous injection has similar effect as skin flap center injection, and intramuscular injection shows the worst effect.

Chen QL, Wang G, Zi QL, He JG, Chen XH, Wen SF, Yang YF, Liu JH.Influence of quantified papaverine by different injection approaches on peripheral resistance of grafting skin flaps.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(5):868-871(China) [www.zglckf.com/zglckf/ejournal/upfiles/08-5/5k-868(ps).pdf]