布托啡诺预给药对下肢缺血再灌注诱发心肌损伤的保护作用

Effects of butorphanol pretreatment on myocardial injury induced by limb ischemia/reperfusion

目的观察布托啡诺预给药对下肢缺血再灌注诱发心肌损伤的保护作用。方法选择下肢远端骨折患者40例，ASA分级I或Ⅱ级，按随机数字表法分为布托啡诺组和对照组，每组20例。所有患者均选择硬膜外麻醉，布托啡诺组在上止血带前15rain静脉注射布托啡诺注射液0．04mg／kg，对照组以0．9％氯化钠代替。两组分别于上止血带前（rrn），第2次松止血带后5min（T1）、2h（T2）、6h（T3）、12h（T4）及24h（T5）颈内静脉采血5ml，检测血清肌酸激酶同工酶MB（CK-MB）、心肌肌钙蛋白I（cTnI）及肿瘤坏死因子-α（TNF-α）和丙二醛（MDA）水平。结果与L比较，对照组CK—MB水平T2-T5明显升高，cTnI、MDA、TNF．d水平T1～T5明显升高，差异有统计学意义（P〈0．05），布托啡诺组CK-MB水平T3，T4明显升高，TNF-α水平T1～T3明显升高，cTnI水平T1～T5明显升高，差异有统计学意义（P〈0．05）；与对照组比较，布托啡诺组CK—MB水平T1～T5降低[（20．2±5．0）U／L比（35．3±6．8）U／L、（32．3±3．7）U／L比（48．6±8．5）U／L、（29．5±5．4）U／L比（51．5±8．0）U／L、（22．2±4．8）U／L比（33．7±6．7）U／L]，eTnI、TNF-α水平T1～T5明显降低[（0．158±0．016）μg／L比（0．278±0．021）μg/L、（0．169±0．036）μg／L比（0．332±0．062）μg／L、（0．3574-0．049）μg/L比（0．623±0．083）μg／L、（0．178±0．045）μg/L比（0．383±0．059）μg，L、（0．138±0．016）μg／L比（0．263±0．023）μg/L；（1．63±0．13）μg，L比（2．12±0．08）μg/L、（1．69±0．08）μg／L比（2．28±0．09）μg／L、（1．63±0．09）μg／L比（2．25±0．07）μg／L、（1．23±0．14）μg／L比（1．93±0．12）μg／L、（1．13±0．15）μg／L比（1．79±0．07）μg／L]，MDA水平Tl～T4明显降低[（4．82±0．53）nmol]L比（6．68±0．67）nmol／L、（4．99±0．61）nmo]／L比（7．59±0．72）nmol／L、（5．02±0．43）nm01]L比（7．54±0．63）nm01]L、（4．52±0．55）nmo]]L比（6．52±0．47）nmo]／L]，差异有统计学意义（P〈0．05）。结论布托啡诺预给药可以降低血清CK—MB、cTnI升高幅度，对下肢缺血再灌注诱发心肌损伤具有保护作用。

Objective To investigate the effects of butorphanol pretreatment on myocardial injury induced by limb ischemia/reperfusion. Methods Forty patients with distal lower extremity orthopedic surgery （ASA Ⅰ or Ⅱ ） were divided into two groups by random digits table method with 20 cases each： butorphanol group and control group. Epidural anesthesia was selected in all patients. In butorphanol group, patients were given butorphanol 0.04 mg/kg intravenously 15 min before tourniquet. In control group,equal volume of normal saline was infused at the same time. Blood samples were taken from jugular vein before tourniquet （To）,then 5 min（T1）, 2 h （T2） ,6 h （T3） , 12 h （T4） and 24 h （T5） after the second reperfusion of tourniquet. The serum creatine kinase isoenzyme MB （CK-MB）, cardiac troponin I （cTnI）, tumor necrosis factor - ct （TNF-ct ） and malondialdehyde （MDA） levels were determined. Results Compared with those at To, the serum CK-MB levels were increased at T2 - Ts, the serum cTnI, MDA, TNF- a levels were increased at T~ - T5 in control group, and there were significant differences （P 〈 0.05 ）. Compared with those at To, the serum CK-MB levels were increased at T3,T4,the serum TNF-c~ levels were increased at T1 -T3,the serum cTnI levels were increased at T1 - T5 in butorphanol group, and there were significant differences（P 〈 0.05 ）. Compared with those in control group,the serum CK-MB levels were decreased at T2 - T5 [ （20.2 ±5.0） U/L vs. （35.3 ±6.8） U/L, （32.3±3.7） U/L vs. （48.6 ±8.5） U/L, （29.5±5.4） U/L vs. （51.5 ±8.0） U/L, （22.2 ±4.8） U/L vs. （33.7 ＋6.7） U/L],the serum cTnI, TNF-ot levels were decreased at T1 -T5 [（0.158±0.016）μg/L vs.（0.278±0.021）μg/L、（0.169±0.036）μg/Lvs.（0.332±0.062）μg/L、（0.357±0.049）μg/Lvs.（0.623±0.083）μg/L、（0.178±0.045）μg/Lvs.（0.383±0.059）μg,L、（0.138±0.016）μg/Lvs.（0.263±0.023）μg/L;（1.63±0.13）μg,L （2.12±0.08）μg/L、（1.69±0.08）μg/Lvs.（2.28±0.09）μg/L、（1.63±0.09）μg/Lvs.（2.25±0.07）μg/L、（1.23±0.14）μg/Lvs.（1.93±0.12）μg/L、（1.13±0.15）μg/L （1.79±0.07）μg/L],the serum MDA levels were decreased at Tx -T4 [（4.82±0.53） nmol/L vs. （6.68±0.67） nmol/L, （4.99±0.61） nmol/L vs. （7.59±0.72） nmol/L, （5.02 ±0.43） nmol/L vs. （7.54±0.63） nmol/L, （4.52 ±0.55） nmol/L vs. （6.52±0.47） nmol/L] in butorphanol group,and there were significant differences （P 〈0.05）. Conclusion Butorphanol pretreatment can improve the serum C K-MB, cTnI levels, and has a protective role for myocardial injury induced by limb ischemia/reperfusion.