川芎嗪联合乌司他丁对断肢再植缺血再灌注损伤的保护作用

Effect of Ligustrazine Combined with Ulinastatin on Protecting Ischemia-reperfusion Injury in Limb Replantation

目的:评价川芎嗪和乌司他丁对断肢再植缺血再灌注损伤的保护作用。方法:40例上肢离断再植病人,随机分为4组,A组为对照组,围手术期不接受川芎嗪和乌司他丁。B组为乌司他丁组,于再植后动脉开放前给予乌司他丁0.5万U/kg。C组为川芎嗪组,于再植后动脉开放前给予川芎嗪2.5 mg/kg。D组为联合组,于再植后动脉开放前分别给予乌司他丁0.5万U/kg、川芎嗪2.5 mg/kg。分别于术前(T1)、术中再灌注后30 min(T2),术后3 h(T3)、24 h(T4)、72 h(T5)共5个时点采集中心静脉血,测定患者血清天冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、丙二醛(MDA)和超氧化歧化酶(SOD)的含量在该过程中的变化。结果:血清AST、CK、MDA的含量在A组、B组、C组有升高趋势,与A组比较,B、C组的AST、CK在不同时点上升幅度较小,有显著性差异(P<0.05)。D组无明显上升,有非常显著性差异(P<0.01)。血清LDH的含量在A组有上升趋势,B、C、D组无明显上升,与A组比较在T2时点有显著性差异(P<0.05)。血清SOD的含量在A、B、C组有降低趋势,B、C组下降幅度较小,与A组比较有显著性差异(P<0.05)。D组无明显下降,与A组比较有非常显著性差异(P<0.01)。结论:川芎嗪和乌司他丁对断肢再植缺血再灌注损伤具有一定的保护作用,联合使用效果更佳。

Objective To evaluate the effect of ligustrazine and ulinastatin on protecting isehemia - reperfusion injury after limb replantation. Methods Forty cases with epipodite replantation were randomly divided into group A （control group, treated without ligustrazine nor ulinastatin in perioperative period）, group B （ulinastatin group, treated with ulinastatin 5000 units/kg before opening artery in limb replantation）, group C （ligustrazine group, treated with ligustrazine 2. 5mg/kg before opening artery in limb replantation） and group D （combination group, treated with ligustrazine 2.5mg/kg and ulinastatin 5000 units/kg before opening artery in limb replantation）. At five time points （i. e.preoperation, 30 minutes after intra - operative reperfusion and post - operative 3 hours, 24 hours and 72 hours）, blood samples were collected from the superior vena cava to assay the levels of AST, CK, LDH, MDA and SOD, respectively. Results The levels of serum AST, CK and MDA in group D did not change much significant from those in group A （P 〈 0.01）, but those in group A, group B and group C increased. The level of LDH in group A increased, but in group B, group C and group D did not obviously increased. At q＇2, the level of LDH in group B, group C or group D was significantly different from that in group A. The level of SOD in group D did not obviously change, which was significantly different from that in group A （ P 〈 0.01 ）, but those in group A, group B and group C decreased. Conclusion Ligustrazine and ulinastatin showed the effect on protecting isehmiareperfusion injury in limb replantation.