舒芬太尼及甲泼尼龙琥珀酸钠对家兔再植肢体缺血再灌注损伤的影响

Effect of sufentanil and methylprednisolone on ischemia-reperfusion injury in replantation limb of rabbit

目的观察舒芬太尼及甲泼尼龙琥珀酸钠(米乐松)对家兔断肢再植肢体缺血再灌注损伤的影响。方法将雄性家兔40只随机分为4组,每组10只。A组(对照组)仅作断肢再植,不给予干预措施。B组(舒芬太尼组)于术中术后给予舒芬太尼干预;C组(米乐松组)术中术后给予米乐松干预;D组(联合组)同时给予舒芬太尼及米乐松的干预。于再灌注后4h、24h,72h取缺血肢体的肌肉组织,观察其Bax和Bcl-2基因表达的变化及24h肌肉超微结构的变化。结果与A组相比,B组术后4h和24h Bax基因及Bcl-2表达无显著变化(P>0.05),72h Bax基因表达降低,Bcl-2表达增高(P<0.05);C、D组在各时间点,Bax基因表达降低,Bcl-2表达增高(P<0.05);C、D组与B组比较,在各时间点,Bax基因表达降低,Bcl-2表达增高(P<0.05)。与C组比较,D组各时点Bcl-2表达增高,Bax基因表达降低,差异均有统计学意义(P<0.05)。结论舒芬太尼术中应用对断肢再植的缺血再灌注损伤无保护作用,而术后应用可减轻其损伤;而米乐松术中术后都有保护作用,且两者有协同作用。

Objective To observation the effect of sufentanil and methylprednisolone on ischemia-reperfusion injury in replantation limb of rabbit.Methods 40 adult male rabbits were randomly divided into four groups,each of 10：A group（control group）only did limb replantation without any interruption;B group（sufentanil group） were given sufentanil around replantation;C group（methylprednisolone group） were given methylprednisolone around replantation;D group（combine group） were given sufentanil combined with methylprednisolone.At 4h,24h,72h after replantation,observed the expression of Bax and Bcl-2 gene and ultra-structure changes of re-plant cell with electron microscope.Results Compared with A group,after 4h and 24h Bax and Bcl-2 gene expression of B group was not significantly change（P0.05）,72h Bax gene expression decreased,Bcl-2 expression increased（P0.05）;In C,D groups at each time point,Bax gene expression decreased,Bcl-2 expression increased（P0.05）;C,D group compared with B group,at each time point,Bax gene expression decreased,Bcl-2 expression increased（P0.05）.Compared with the C group,in D group at each time point,Bcl-2 expression increased,Bax gene expression decreased,the difference were statistically significant（P0.05）.Conclusion Sufentanil for intraoperative limb replantation of ischemia-reperfusion injury has without protection,and reduce the damage after the application;But methylprednisolone can use both in and after operation,and there has fortified interaction between them.