全膝关节置换术中气压式止血带对患肢静脉血一氧化氮和内皮素的影响

Effect of pneumatic tourniquet on venous nitricoxide and endothelin levels in wounded limb of patients undergoing total knee arthroplasty

目的探讨全膝关节置换术(TKA)中使用气压式止血带对患肢静脉血一氧化氮(NO)和内皮素(ET)水平的影响。方法择期行TKA的患者40例,20例术中使用气压式止血带(Ⅰ组),20例术中不使用气压式止血带(Ⅱ组)。Ⅰ组于气压式止血带充气前(T1)、气压式止血带放开即刻(T2)、气压式止血带放开1h(T3)及术后第1天(T4),Ⅱ组于术前即刻(T1)、术毕即刻(T2)、术毕1h(T3)及术后第1天(T4),采集患肢股静脉血测定NO和ET水平。结果Ⅰ组在T2时间点的NO水平为(61.76±3.39)μmol/L,显著低于同组T1时间点和Ⅱ组相同时间点(P值均<0.01),各时间点ET水平的差异均无统计学意义(P值均>0.05),但T2时间点的NO/ET值较同组T1时间点和Ⅱ组相同时间点显著降低(P值分别<0.05、0.01)。Ⅱ组各时间点的ET、NO、NO/ET值的差异均无统计学意义(P值均>0.05)。结论 TKA术中使用气压式止血带使患肢的NO水平明显降低,可能会引起患肢缺血-再灌注损伤,对于合并高血压和(或)血管疾病的老年患者行TKA时应充分考虑到止血带的潜在并发症。

Objective To investigate whether pneumatic tourniquet affects venous levels of nitricoxide （NO） and endothelin （ET） in the wounded limb of patients undergoing the total knee arthroplasty （TKA）.Methods Forty patients were scheduled to undergo selective TKA. Half of them （groupⅠ） were allocated in the pneumatic tourniquet group, and the left ones （groupⅡ） were included in the control group without the pneumatic tourniquet treatment. Blood from the femoral vein of the wounded limps in the patients were sampled at following time-points, before pneumatic tourniquet aerating/immediately before operation （baseline, T1）, immediately after pneumatic tourniquet releasing/operation （T2）, 1 h after pneumatic tourniquet releasing/operation （T3） and 24 h after operation （T4）, to measure the levels of NO and ET. Results In groupⅠ, the plasma NO level at T2 was （61.76±3.39） μmol/L, significantly lower than that at T1 and that in groupⅡ at the same time point （P〈0.01）. There was no significant difference in the ET level at each time point （P〉0.05）, but the ratio of NO/ET at T2 was significantly decreased when compared with that at T1 （P〈0.05） and that in groupⅡ at the same time-point （P〈0.01）. No significant differences were found in the levels of ET and NO and the ratio of NO/ET in groupⅡ at each time point （P〉0.05）. Conclusion Using pneumatic tourniquet during TKA can reduce the venous NO level in the patients’ wounded limb and might produce ischemia-reperfusion injury. These potential complications related to pneumatic tourniquet should be taken into account when TKA is applied to the aged patients with hypertension and/or vascular diseases.