摘要
背景:四肢手术中使用止血带常引起缺血再灌注损伤,并可通过炎症机制造成重要器官的损伤。近年来,中药防治骨骼肌缺血再灌注损伤的研究有了很大进展,其有效成分及作用机制可为拓宽应用领域提供新的治疗思路。目的:探讨生脉注射液预先给药对膝关节置换下肢骨骼肌缺血再灌注的保护机制。方法:选择行择期膝关节置换患者60例,随机分为2组,每组30例。生脉注射液组在麻醉诱导前10 min经静脉滴注生脉注射液1 mL/kg(100 m L生理盐水稀释),对照组滴入等量的生理盐水。记录并比较2组患者置换术前、术中、术后血压、心率、动脉血气pH、二氧化碳分压,手术时间和止血带使用时间,对比2组患者上止血带前(T0)、松止血带前(T1)、再灌注1 h(T2)血清肿瘤坏死因子α、白细胞介素8及超氧化物歧化酶、丙二醛水平。结果与结论:(1)生脉注射液组患者术前、术中、术后血压、心率、pH及二氧化碳分压差异均无显著性意义;对照组患者术中血压下降、心率减慢、二氧化碳分压升高,明显低于术前及术后,而p H、标准碳酸氢盐、碱剩余值逐渐降低(P<0.05);生脉注射液组术中血压、心率均高于对照组,二氧化碳分压低于对照组,术中、术后pH、标准碳酸氢盐、碱剩余均高于对照组(P<0.05);(2)2组患者手术时间及止血带使用时间差异均无显著性意义(P>0.05);(3)T0、T1、T2时,对照组超氧化物歧化酶水平逐渐下降,丙二醛、肿瘤坏死因子α、白细胞介素8水平均逐渐升高(P<0.05);而生脉注射液组各指标差异均无显著性意义;与对照组相比,T1、T2时生脉注射液组超氧化物歧化酶活性明显升高,而丙二醛、肿瘤坏死因子α、白细胞介素8水平明显降低(P<0.05);(4)结果表明,生脉注射液具有多靶效应,可改善微循环,提高机体耐缺氧能力,抗炎,改善呼吸功能及稳定血压,可能通过升高血清超氧化物歧化酶活性,降低肿瘤坏死因子α、白细胞介素8、丙二醛水平来防止膝关节置换下肢骨骼肌缺血再灌注损伤的发生。
BACKGROUND： The use of tourniquets in limb surgery often leads to ischemia-reperfusion injury, and can cause important organ damage through inflammation. In recent years, Chinese herbal medicine prevention and treatment of skeletal muscle ischemia-reperfusion injury has made great progress, and its effective composition and mechanism of action can provide new treatment ideas for broadening the application areas.OBJECTIVE： To investigate the protective mechanism of Shengmai injection pretreatment on knee arthroplasty to lower limb skeletal muscle ischemia-reperfusion. METHODS： Sixty cases undergoing elective knee replacement surgery were equally and randomly divided into Shengmai injection group and control group. In the Shengmai injection group, Shengmai injection 1 mL /kg（100 mL diluted with normal saline） was intravenously injected 10 minutes before induction of anesthesia. In the control group, an equal volume of physiological saline was injected. Blood pressure, heart rate, arterial blood gas pH, PaCO_2, surgery time and tourniquet time were recorded before, during and after surgery. Serum tumor necrosis factor-α, interleukine-8, superoxide dismutase, and malondialdehyde levels were compared before tourniquet（T0）, before tourniquet release（T1）, and 1 hour of reperfusion（T2）. RESULTS AND CONCLUSION：（1） Preoperative, intraoperative and postoperative blood pressure, heart rate, p H and PaC O2 were not significantly different between the Shengmai injection and control groups. In the control group, intraoperative blood pressure decreased, heart rate became slow, and carbon dioxide partial pressure increased, which were significantly lower than that before and after surgery, but pH, standard bicarbonate, and alkali residual value were gradually reduced（P〈0.05）. Intraoperative blood pressure and heart rate were higher, but PaCO_2 were lower in the Shengmai injection group compared with the control group. Intraoperative and postoperative pH, standard bicarbonate, and alkali residual value were higher in the Shengmai injection group than in the control group（P〈0.05）.（2） Operation time and tourniquet time were not significantly different between the two groups（P〈0.05）.（3） At T0, T1 and T2, superoxide dismutase levels decreased, while malondialdehyde, tumor necrosis factor-α, and interleukine-8 levels gradually increased in the control group（P〈0.05）. Each indicator was not significant in the Shengmai injection group. Compared with the control group, superoxide dismutase levels were significantly increased at T1 and T2, but malondialdehyde, tumor necrosis factor-α, and interleukine-8 levels significantly reduced in the Shengmai injection group（P〈0.05）.（4） These results suggested that Shengmai injection with multi-target effects can improve microcirculation, the ability of hypoxia, and respiratory function, resist inflammation and stabilize blood pressure, by elevating levels of malondialdehyde, reducing tumor necrosis factor-α, interleukine-8, and malondialdehyde level to effectively prevent lower limb skeletal muscle ischemia-reperfusion injury on knee arthroplasty.
出处
《中国组织工程研究》
CAS
北大核心
2016年第53期7917-7924,共8页
Chinese Journal of Tissue Engineering Research
基金
高等学校博士学科点专项科研基金(20133420110009)~~
