Hyperbaric Oxygenation Augments Cutaneous Collateral Microcirculation and Autonomic Nervous Regulation in Diabetic Rats

高壓氧治療增加糖尿病大鼠表皮側枝循環及自主神經調控

孫宗伯(Tzong-Bor Sun) ； 黃國峯(Kuo-Feng Huang) ； 葉敬淳(Chin-Choon Yeh) ； 牛柯琪(Ko-Chi Niu)

《臺灣整形外科醫學會雜誌》 24卷3期 (2015/09) Pp. 218-228

摘要

背景：糖尿病足部併發症所衍生的各式困難傷口照護問題，始終是整形外科醫師所面對的挑戰。糖尿病患者足部潰瘍產生的成因，在於糖尿病神經病變與血管病變，但至今對於糖尿病所導致的運動神經病變、感覺神經病變、自主神經病變、及表皮側枝循環缺乏，尚無有效的整體治療模式。目的及目標：本研究之目的在於驗證計畫性高壓氧治療，能夠增加糖尿病個體表皮側枝循環，及促進自主神經調控的假說。使用糖尿病大鼠接受高壓氧治療，以釐清其對於自主神經功能失調，及表皮側枝循環低下的影響。材料及方法：以鏈佐黴素腹腔注射誘發大白鼠產生糖尿病，手術植入無線發報器，於恢復日常行動後，取得其體循環動脈壓及脈搏間距無線發報訊號，分析實驗動物接受十次60分鐘、三大氣壓、100%的高壓氧治療後，血壓變異性及心率變異性的變化。以都卜勒血流測量儀，量測下腹壁皮瓣手術獲取前、後的微循環血流，求得表皮側枝循環血流參數。結果：高壓氧治療顯著降低糖尿病大鼠的體循環動脈壓，同時也顯著降低血壓變異性的低頻功率。其對脈搏間距則造成顯著增加，並且顯著增加心率變異性的高頻功率。糖尿病大鼠的下腹壁皮瓣側枝循環明顯低於非糖尿病大鼠，經高壓氧治療後則顯著增加。結論：高壓氧治療有效增加鏈佐黴素誘發糖尿病大鼠的表皮側枝循環，與高壓氧治療後心臟迷走神經調控增強、血管交感神經調控降低同時表現。

並列摘要

Background:Problem wound healing remains challenging for plastic surgeon who deal with diabetic individuals with foot complications. Diabetic neuropathy and angiopathy are important factors contributing to diabetic foot ulceration. Effective treatments for diabetic motor, sensory, autonomic neural dysfunction and shortage of collateral circulation are lacking.Aim and Objectives:We hypothesized that programmed hyperbaric oxygenation would improve the cutaneous collateral circulation and autonomic nervous system modulation in individuals with diabetic mellitus. The purpose of this study was to validate the effect of hyperbaric oxygen on the dysfunctions of the autonomic nervous system and regional cutaneous microcirculation in diabetic rats.Materials and Methods:Wireless telemetric signals of systemic arterial pressure and pulse-pulse intervals were obtained from rats with streptozotocin-induced diabetes. We analyzed the effects of ten 60-minute hyperbaric oxygenation treatments (100% oxygen, and 3 absolute atmospheres) on daily blood pressure variability and heart rate variability. Cutaneous microcirculation was measured with laser Doppler flowmetry before and after epigastric flap elevation.Results:Hyperbaric oxygenation led to a significant reduction in systemic arterial pressure and low-frequency power of blood pressure variability and resulted in a significant increase in pulse-pulse interval and high frequency power of heart rate variability. Collateral cutaneous blood flow to the epigastric flaps significantly decreased in diabetic rats. The blood flow was significant increased in diabetic rats that underwent hyperbaric oxygenation.Conclusion:Hyperbaric oxygen therapy effectively increases the collateral cutaneous circulation in rats with streptozotocin-induced diabetes. It would be related to increasing of the cardiac vagal modulation and decreasing of the vascular sympathetic activities.

並列關鍵字

diabetes mellitus ； problem wounds ； hyperbaric oxygenation ； collateral circulation ； autonomic nervous system