喷他佐辛对止血带致下肢缺血/再灌注后心肌肌钙蛋白Ⅰ的影响

Effect of pentazocine on the alteration of cardiac troponin Ⅰ in leg ischemia/reperfusion induced by tourniquet

目的 观察喷他佐辛对下肢缺血/再灌注（ischemia/reperfusion,I/R）后心肌肌钙蛋白Ⅰ（cardiac troponin Ⅰ,cTnⅠ）的影响及其与降钙紊基因相关肽（calcitonin gene-related peptide,CGRP）的关系. 方法 选取择期在蛛网膜下腔麻醉下行单侧下肢骨科手术使用止血带患者60例,按照随机数字表法分为对照组（C组）和喷他佐辛组（P组）,每组30例.止血带充气前P组患者给予喷他佐辛0.5 mg/kg静脉滴注,C组在相同时刻给予等量生理盐水.在止血带充压前（To）及止血带释压后0.5 h（T0、24 h（T2）时采集输液对侧肘静脉血5 nl,采用ELISA法检测血清中cTnⅠ和CGRP的含量. 结果 两组患者一般资料比较,差异无统计学意义（P＞0.05）.与To时cTnⅠ[（0.2 1±0.06）μg/L]比较,C组cTnⅠ在T1时无明显变化（P＞0.05）,在T2[（0.28±0.10） μg/L]时明显升高（P＜0.05）,P组cTnⅠ在T1、T2时无明显变化（P＞0.05）;与To时CGRP[（16.9±2.2） ng/L]比较,C组CGRP在T1、T2时均无明显变化（P＞0.05）,P组CGRP在T1[（17.9±2.7） ng/L]、T2[（18.8±2.8） ng/L]时均明显升高（P＜0.05）.与C组在T1、T2时cTnⅠ[（0.23±0.12）、（0.28±0.10） μg/L] 、CGRP[（16.9±1.9）、（16.7±2.6） ng/L]比较,P组的cTnⅠ在T1时无明显变化（P＞0.05）,T2[（0.22±0.06） μg/L]时明显降低（P＜0.05）,P组的CGRP在T1、T2时均明显升高（P＜0.05）. 结论 喷他佐辛可以减轻下肢使用止血带诱发I/R后的cTnⅠ升高,可能与内源保护性神经肽CGRP有关.

Objective To explore the effect of pentazocine on the changes in cardiac troponin Ⅰ （cTnⅠ） and its association with calcitonin gene-related peptide （CGRP） in tourniquet-induced leg ischemia/reperfusion （Ⅰ/R）.Methods Sixty patients,undergoing elective unilateral leg surgery using tourniquet,under spinal anesthesia,were enrolled and randomly assigned to control group （group C） and pentazocine group （group P）（n=30）,in accordance with a random number table.Patients in group P pretreated with pentazocine 0.5 mg/kg before surgery,while only the same volume of saline was infused intravenously in group C at the same schedule.5 ml of blood samples were collected from cubital vein in a not transfusion ann immediately before inflating tourniquet （To）,0.5 h（T1） and 24 h（T2） after tourniquet deflation.Serum concentration of cTnⅠ and CGRP were measured by ELISA.Results There was no statistical difference detected in the general information in two groups （P〉0.05）.Compared with the cTnⅠ at the time of To [（0.21±0.06） μg/L] the concentration of cTnⅠ in group C at the time of T1 was not obvious changed （P〉0.05）,while significantly increased at the time of T2 [（0.28±0.10） μg/L]（P〈0.05）,the concentration of cTnⅠ in group P was no obvious changed at the times of T1 and T2（P〉0.05）.No significant change in the concentration of CGRP of group C was detected at the time of T1 and T2（P〉0.05）,while CGRP in group P was increased significantly at the time of T1[（17.9±2.7） ng/L] and T2[（18.8±2.8） ng/L]（P〈0.05）,compared with CGRP at the time of To [（16.9±2.2） ng/L].Compared the cTnⅠ and CGRP with group C at the times ofT1 [（0.23±0.12） μg/L,（16.9±1.9） ng/L] and T2 [（0.28±0.10） μg/L,（16.7±2.6） ng/L],no significant change in the concentration of cTnⅠ of group P was detected at the time of T1 （P〉0.05）,cTnⅠ in group P was decreased significantly at the time ofT2 [（0.22±0.06） μg/L vs （0.28±0.10） μg/L]（P〈0.05）,CGRP in group P was increased obviously at T1 and at T2 （P〈0.05）.Conclusions The results of this study indicates that pentazocine may attenuate myocardial injury induced by leg I/R tourniquet,in which endogenous CGRP may be associated.