高渗氯化钠羟乙基淀粉40注射液对下肢缺血再灌注损伤的影响

Effect of hypertonic sodium chloride hydroxyethyl starch 40 injection on the ischemia reperfusion injury of lower extremity

目的探讨高渗氯化钠羟乙基淀粉40(HSH40)注射液对止血带引起的下肢缺血再灌注损伤的影响。方法将20例ASAI-Ⅱ级择期全麻行单膝关节置换手术的患者随机分为HSH40注射液组(n=10)、对照组(n=10),检测止血带充气前及放气后5、10、20min血清肌酸磷酸激酶(CPK)、乳酸脱氢酶(LDH)活性、丙二醛(MDA)含量。结果两组患者与充气前对比,患者血清LDH在放气后5min下降,10、20min逐渐恢复,血清MDA在放气后5min升高,10、20min逐渐恢复,两组的LDH和MDA含量在各时点比较无统计学意义(P>0.05),CPK两组在松止血带前后亦无统计学意义(P>0.05)。结论全麻下行下肢骨科手术时使用止血带,患者血清LDH和MDA有一定变化,松止血带后5min内影响最大,为一过性改变;和对照组比较,HSH40对MDA、LDH、CPK的影响差异无统计学意义。

Objective To investigate the effects of hypertonic sodium chloride hydroxyethyl starch 40 injection on the tourniquet-induced lower extremity ischemia-reperfusion.Methods 20（ASA I-Ⅱ） cases who underwent selective TKR（total knee replacement） under general anesthesia were randomly divided into 2 groups： HSH 40 group（n=10） and control group（n=10）.CPK,LDH and MDA were measured before inflation and 5,10 and 20 minutes respectively after deflation of tourniquet.Results Comparing with pre-inflation of tourniquet,LDH in 2 groups decreased at 5 minutes after deflation and began to gradually recover at 10,20 minutes after deflation and MDA in 2 groups started to increase at 5 minutes after deflation and gradually recovered at 10 to 20 minutes after deflation.LDH and MDA in 2 groups did not have statistical difference at each time point（P〉0.05）.CPK in 2 groups did not change dramatically before and after deflation of tourniquet.Conclusion During orthopedic surgery for lower extremities under general anesthesia,tourniquets have a certain effect on the serum LDH and MDA.The greatest effect happens within the 5 minutes after deflation and is transient.MDA,LDH and CPK in HSH40 group are not affected significantly compared with those in control group.