缺血预处理对肢体缺血再灌注损伤的影响

The effect of ischemic preconditioning on ischemia reperfusion damage in human limbs

目的 观察缺血预处理 (IPC)对肢体缺血再灌注损伤的影响。方法 选择 2 0例需充气止血带止血进行手术的患者 ,随机分为对照组 (n =10 )和IPC组 (n =10 )。IPC组患者术前应用 3次 5min循环缺血 ,间隔 5min再灌注预处理后在止血带下进行手术 ;对照组直接在止血带下进行手术。在肢体缺血前和再灌注 30min、90min、180min分别取静脉血检测血清肌酸磷酸激酶 (CPK)、谷草转氨酶(AST)、乳酸脱氢酶 (LDH)、丙二醛 (MDA)和过氧化物歧化酶 (SOD)水平。结果 随着肢体缺血再灌注时间的延长 ,血中CPK、AST、LDH、MDA含量逐渐升高 ,而SOD活性逐渐降低。IPC组在缺血前及再灌注同时间 ,血中CPK、AST、LDH、MDA含量低于对照组 (P <0 0 5 ,P <0 0 1) ;而SOD活性高于对照组 (P <0 0 5 ,P <0 0 1)。结论 IPC能有效地减轻肢体缺血再灌注损伤程度 ,减轻脂质过氧化反应 。

Objective To observe the effect of ischemic preconditioning on human limbs ischemia reperfusion damage. Methods 20 cases were divided randomly into two groups: the control group( n =10) and the IPC group( n =10). Before operation, patients in the IPC group were sustained 3 cycles of 5 minutes ischemia and 5 minutes reperfusion ischemic preconditioning, after that the two groups were treated under the pneumatic tourniquet. Serum CPK, AST, LDH, MDA and SOD were assayed respectively before limb ischemia, and 30 min,90 min, 180 min after reperfusion. Results With the time of ischemia reperfusion lengthening, plasma CPK, AST, LDH, MDA significantly increased in both groups, while the activity of plasma SOD significantly decreased. The level of plasma CPK, AST, LDH and MDA in the IPC group significantly reduced by comparing with control group ( P <0 05, P <0 01), while the activity of SOD dramatically enhanced in the IPC group by comparing with control group ( P <0 05, P <0 01). Conclusion IPC can reduce the damage of ischemia reperfusion and lipid peroxidation, and enhance the tolerance of limb ischemia. It can effectively prevent the reperfusion damage of the limb ischemia.