乌司他丁对下肢缺血-再灌注损伤的影响

Effect of ulinastatin on lower extremity ischemia-reperfusion injury

目的观察乌司他丁对下肢缺血-再灌注期间氧自由基(OFR)代谢物丙二醛(MDA)以及促炎性细胞因子肿瘤坏死因子α(TNF-α)的影响。方法将20例单侧下肢手术病人随机分为乌司他丁组(U组,n=10)和对照组(C组,n=10)。均采用连续硬膜外麻醉。U组于上止血带前15min静脉滴注乌司他丁20万单位,松止血带前5min再次推注10万单位;C组以等量生理盐水于相同时间静脉注射。于上止血带前(T1)、松止血带后5min(T2)、15min(T3)和30min(T4)抽取术侧股静脉血,测定MDA、TNF-α浓度。结果C组在T2、T3、T4时MDA含量较T1时显著增加(P<0·01),U组仅T4时较T1时增加(P<0·05)。C组TNF-α于T3、T4时较T1时显著增高(P<0·01),U组各时点较T1时差异无显著性。结论乌司他丁对下肢缺血-再灌注损伤中OFR代谢物MDA以及促炎性细胞因子TNF-α的产生有一定抑制作用。

Objective To assess the effect of ulinastatin on the changes in lipid peroxides(MDA) and tumor necrosis factor-α(TNF-α) after ischemia-reperfusion of lower extremity.Methods Twenty ASA Ⅰ patients scheduled for lower extremity surgery were randomly allocated to ulinastatin group(group U,n=10) and control group(group C,n=10).Continual epidural anesthesia was performed in both groups.Ulinastatin 200,000 U was intravenously dripped 15min before tourniquet roped,and 100,000 U before tourniquet loosen 5min in group U.The same volume of saline was given at the same time points in group C.The femoral vein blood of operation side was drawn before tourniquet roped(T_1),after tourniquet loosen 5min(T_2),15min(T_3) and 30min(T_4) for the measurements of MDA and TNF-α.Results In group C,plasma MDA concentrations were significantly increased at T_2,T_3 and T_4 compared with those at T_1(P<0.01).In group U,MDA concentrations were significantly increased only at T_4(P<0.05),and were significantly depressed at T_2,T_3 and T_4,compared with those at the same time points in group C(P<0.05).In group C,plasma TNF-α concentrations were significantly increased at T_3 and T_4 compared with those at T_1(P<0.01).TNF-α concentrations were significantly depressed at T_3 and T_4,compared with those at T_1 in group C(P<0.05).Conclusion Ulinastatin can attenuate ischemia-reperfusion injury of lower extremity by promoting the clearance of lipid peroxides and inhibiting inflammatory factors. [