参麦注射液减轻肢体缺血再灌注后肺功能障碍的机制研究

Effect of Shenmai Injection on Pulmonary Dysfunction after Tourniquet-induced Limb Ischemia-reperfusion

目的观察参麦注射液对使用止血带的下肢手术患者肺功能的影响及可能的机制。方法选择单侧下肢手术患者41例,年龄20～60岁,体重指数18～28kg/m2,ASA分级Ⅰ或Ⅱ级,止血带持续充气或手术时间1.0～1.5h,根据是否应用止血带分为无止血带组(N组,n=15)和止血带组,再将止血带组患者按单盲法随机分为缺血再灌组(I/R组,n=14)和参麦组(SM组,n=12)。所有患者于L1,2或L2,3间隙行腰麻-硬膜外联合阻滞,感觉阻滞平面控制在T8以下。SM组在上止血带前15min将参麦注射液0.6ml/kg加入100ml生理盐水静脉滴注完毕,而I/R组则在相同时间内静脉滴注等量生理盐水。3组患者于扎止血带/手术开始前即刻(T0)、止血带松开后/术后0.5h(T1)、2h(T2)、6h(T3)和24h(T4)时分别采集桡动脉血样行血气分析,测定血浆丙二醛(MDA)、血清白细胞介素6(IL-6)和IL-8浓度。结果与T0比较,I/R组T3时PaO2降低,PA-aDO2、RI和血浆MDA浓度升高,血清IL-6和IL-8浓度在T3～4时升高,SM组血清IL-6浓度T3时升高(P<0.05或0.01),N组和SM组各时点各项指标差异无统计学意义(P>0.05);与N组比较,I/R组PaO2降低,PA-aDO2、RI、血浆MDA浓度、血清IL-6和IL-8浓度升高(P<0.05或0.01);与I/R比较,SM组PaO2升高,PA-aDO2、RI、血浆MDA浓度、血清IL-6和IL-8浓度降低(P<0.05或0.01)。结论单侧下肢手术患者,止血带的应用可导致肺换气功能障碍,参麦注射液可有效改善患者的肺换气功能,机制可能与其抑制氧自由基脂质过氧化和全身炎症反应有关。

To investigate the effect of unilateral thigh tourniquet - induced lower limb ischemia - reperfusion on pulmo- nary function, and the protective effect of Shenmai injection. Methods Forty one ASA I or II patients, aged 20 - 60years old, body mass index 18 -28kg/m2 , whose tourniquet inflation or operation duration varied from 1.0 to 1.5h, scheduled for unilateral lower extrem- ity surgery, were divided into 2 groups. Non - tourniquet group （group N, n = 15） included all patients with femoral shaft fractures opera- ted on without a tourniquet. Tourniquet group composed of patients operating for tibial or ankle fractures with a tourniquet. Then the pa- tients of tourniquet group were randomly divided into two groups by blind trial：ischemia - reperfusion group （ group I/R, n = 14） and Shen- mai injection group（ group SM, n = 12）. All the patients agreed to a combined spinal- epidural anesthesia at the L1 -L2 or L2 -L3 inter- space,and the upper sensory block level was kept below Ts. Patients in group SM were injected Shenmai injection 0.6ml/kg and physio- logical saline 100ml, while patients in group I/R were injected equal volume of normal saline instead 15 mins before tourniquet inflation. A radial artery catheter was placed for sampling. Radial arterial blood samples were collected immediately before tourniquet inflation or op- eration beginning （ baseline）, and 0.5, 2, 6 and 24h after tourniquet deflation or operation ending for blood gas analysis and measurement of plasma malondialdehyde （ MDA）, serum interleukin - 6 （ IL - 6） and IL - 8 levels. Results Compared with the baseline values at To, PaO2 at T3 was significantly decreased, while PA-, DO2 RI and the levels of plasma M DA at T3 , serum IL -6 and IL -8 at T3 -4 in group I/ R, and the levels of serum IL -6 at T3 in group SM were significantly increased （P 〈 0.05 or 0.01 ）. Compared with group N, PaO2was decreased, while PA_ DO2 RI and the levels of plasma MDA and serum IL- 6 IL- 8 were increased in group I/R （P 〈 0.05 or 0.01 ）. All the changes mentioned above were significantly mitigated in group SM compared with group SM （P 〈 0.05 or 0.01 ）. Conclusion Pulmonary gas exchange is impaired after lower limb ischemia - reperfusion induced by clinical tourniquet application Shenmai injectioncan mitigate pulmonary dysfunction via inhibiting lipid peroxidation and the releasing of IL - 6 and IL - 8.