参麦注射液对下肢止血带诱发的肺换气功能损伤及IL-6、IL-8的影响

Effect of the Shenmai Injection on Pulmonary Gas Exchange Impairment,Cytokine Interleukin-6(IL-6) and Cytokine Interleukin-8(IL-8) Induced by Lower Extremity Tourniquet Deflation

目的:观察参麦注射液对下肢止血带诱发肢体缺血再灌注肺换气功能损伤及血清细胞因子IL-6,IL-8水平的影响。方法:单侧下肢手术患者(需要止血带)26例,按单盲法随机分为对照组(C组,n=14)和参麦注射液组(SM组,n=12),于L2,3间隙行脊椎-硬膜外联合阻滞。SM组于上止血带15min前将参麦注射液0.6mL/kg加入100mL生理盐水静脉滴注完毕,C组在相同时间内滴注等量的生理盐水。动态观察两组患者上止血带前(T0)、松止血带后30 min(T1)、2h(T2)、6h(T3)、24h(T4)血气指标及血清IL-6和IL-8的浓度变化。结果:与T0时比较,C组T3动脉血氧分压降低,肺泡-动脉血氧分压差、呼吸指数、IL-6和IL-8浓度升高(P<0.01);SM组T3时点IL-6浓度有所升高(P<0.01),各时点血气指标和血清IL-8浓度比较差异无统计学意义(P>0.05)。与C组比较,SM组松止血带后的动脉血氧分压降低幅度减慢,肺泡-动脉血氧分压差、呼吸指数、血清IL-6和IL-8浓度升高幅度降低(P<0.05)。结论:下肢止血带的应用可诱发肢体缺血再灌注性肺损伤,参麦注射液具有改善肺损伤,其机制可能与抑制促炎因子表达,下调血清IL-6、IL-8浓度水平有关。

Objectlve：To investigate the effect of Shenmai Injection on pulmonary gas exchange, cytokine imerleukin-6 （IL- 6 ） and eytoklne interleukin -8 （IL- 8） induced by tourniquet deflation in patients undergoing lower extremity surgery. Methods： Twenty- six patients schedtded for unilateral lower extremity surgery were randomly divided into 2 groups： control group （group C,n=14） and Shenmai Injection group （group SM, n=12）. All the patients agreed to a combined spinal- epidural anesthesia at th~ I2 - L3 interspace and a radial artery catheter was placed for sampling. Patients in group SM were injected Shenmai Injection 0.6mL/kg and physiological saline 100mL, while patiems in group C were injec- ted equal volume of normal saline instead 15 rains before tourniquet inflation. Blood samples which were used for blood gas analysis and measurement of interleukin - 6 （ IL - 6） and interleukin - 8 （ IL - 8 ） were taken before tourniquet inflation （TO, baseline） and 30min （T1）, 2h （T2）, 6h （T3）, 24h （Tg） after tourniquet deflation. Results：Compared with the baseline values at TO, PaO2 was significantly decreased （P 〈 0.05 or 0.01 ）, while PA - aDO2, the levels of IL - 6 and IL - 8 were significantly increased （ P 〈 0.05 or 0.01 ） at I3 in group C ; The level of IL - 6 was significantly increased （P 〈 0.05） at 13 in group SM and other data had no statistical significance （P 〉 0.05）. Compared with group C, the changes of PaO2, PA- aDO2, IL-6 and IL-8 were significantly mitigated in group SM （P 〈0.05）. Conclusion：The effect of Shen- mai Injection on inhibiting the pro - inflammatory mediator and regulate the level of production of IL - 6 and IL - 8 may be one reason of rivalry the pulmonary gas exchange impairmem induced by lower extremity tourniquet application.