人工全膝关节置换影响红细胞脂质过氧化的研究

Effect of the lipid peroxide in erythrocytes in total knee replacement

[目的]探讨人工全膝关节置换术对围手术期红细胞脂质过氧化的影响及维生素E(VitE)、1,6-二磷酸果糖(FDP)对红细胞脂质过氧化的防治作用。[方法]膝关节退变伴骨性关节炎患者60例,于硬膜外阻滞麻醉下行人工全膝关节置换术,随机分为四组:即对照组、术前应用维生素E组、术中应用FDP组及术前应用维生素E联合术中应用FDP组。每组15例,在手术前、术后1、3、5、7d抽取血样,测定红细胞中丙二醛(MDA)和铜-锌-超氧化物歧化酶(Cu-Zn-SOD)的含量。[结果]人工全膝关节置换术后红细胞中MDA的含量明显比术前增高(P<0.05),而Cu-Zn-SOD的含量明显比术前降低(P<0.05);术前应用VitE联合术中应用FDP比单纯应用VitE或FDP能在围手术期更有效地保护红细胞免受脂质过氧化的损伤(P<0.05)。[结论]人工全膝关节置换术,应提倡术前服维生素E和术中用FDP,以预防围手术期氧自由基和过氧化脂质等有害因子对红细胞的破坏,以及因红细胞损伤可能出现的深静脉血栓形成等并发症的发生。

[ Objective] To evalvate the influence of total knee replacement（TKR） on the lipid peroxdation in erythrocytes, and the prophylactic treatment of Vitamin E and fructose 1, 6-diphosphate（FDP） on it. [ Method] Totally 60 patients of knee osteoarthritis were divided into control group, Vitamin E group, Fructose 1,6-diphosphate （FDP） group and Vitamin E added FDP group. Blood samples were taken for biochemical determination of MDA and Cu-Zn-SOD before and after the operation at 1, 3, 5 and 7 days. [ Result] MDA level in erythrocytes increased singnificantly after TKR compared with that before operation （P 〈 0. 05 ） ,while Cu-Zn-SOD level decreased singnificantly （P 〈 0. 05 ）. When l OOmg vitamin E was given by mouth three times daily for three days before operation, and FDP 10 grams was intravenously infused during operation, there was no significant change of MDA and Cu-Zn-SOD. [ Conclusion] The result suggests that Vitamin E and FDP can pretect erythrocytes from lipid peroxidation during operation. Vitamin E ang FDP provide a protective effect on erythrocytes on the course of the operation.