布托啡诺对止血带致肢体缺血-再灌注损伤的影响分析

Clinical Effect of Butorphanol on Tourniquet-Induced Limb Ischemia-Reperfusion Injury

目的分析布托啡诺对肢体缺血-再灌注损伤后MDA含量、SOD活性、TNF-α和IL-8水平的影响,探讨其在止血带致肢体缺血-再灌注损伤中的应用价值。方法60例ASAⅠ~Ⅱ级在腰硬联合麻醉下行单侧胫腓骨骨折内固定术的患者,随机分成布托啡诺组和对照组各30例,布托啡诺组于上止血带前10 min静脉入壶滴注布托啡诺1 mg,对照组不给布托啡诺。分别于上止血带前5 min(T0),松止血带后5(T1)、30(T2)、60 min(T3)4个时间点抽取患肢股静脉血,硫代巴比妥酸法测定MDA含量,黄嘌呤氧化酶法测定SOD活性,酶联免疫吸附试验测定肿瘤坏死因子-α(TNF-α)和白介素-8(IL-8)的水平。结果与T0时点比较,2组T1、T2、T3时点MDA含量、TNF-α和IL-8水平均明显升高,SOD活性明显降低(P<0.05)。2组间患者T0时刻MDA含量、SOD活性、TNF-α和IL-8水平差异无统计学意义;在T1、T2、T3时点,布托啡诺组SOD活性明显高于对照组(P<0.05),MAD含量、TNF-α和IL-8水平显著低于对照组(P<0.05)。结论布托啡诺能减轻止血带致肢体缺血-再灌注损伤,其机制可能与布托啡诺能清除氧自由基、降低止血带诱发的炎性因子表达有关。

Objective To investigate the clinical effect of butorphanol on various indexes(MDA content,SOD activity,levels of TNF-αand IL-8)after limb ischemia-reperfusion injury.Methods 60 middle-aged patients with ASA grade from I toⅡwho underwent unilateral fracture of tibia and fibula internal fixation under combined spinal and epidural anesthesia were randomized into experimental group and control group with 30 in each.Before tourniquet,butorphanol was infused 1 mg intravenously into the kettle on the top 10 mins to experimental group,while control group was not processed.At four time points in this study,such as,5 mins before the tourniquet(T0),5 mins after the loose tourniquet(T1),30 mins after the loose tourniquet(T2),and 60 mins after the loose tourniquet(T3),these two groups were drawn blood from femoral vein of the affected limb.Then the contents of MDA were tested by the method of thiobarbituric acid,the activity of SOD measured by xanthine oxidase method,and enzyme-linked immunosorbent assay used to test the level of TNF-αand IL-8.Results Intra group comparison:compared with T0,the levels of MDA,TNF-αand IL-8,at T1,T2,T3 in these two groups were significantly increased,and the activity of SOD was significantly reduced(P<0.05);inter group comparison:there were no significant difference in MDA,SOD,TNF-αand IL-8 between the two groups at T0.At T1,T2,and T3,the level of SOD in experimental group was significantly higher than that in control group(P<0.05),and the levels of MAD,TNF-αand IL-8 in control group were significantly higher than those in experimental group(P<0.05).Conclusion Butorphanol can reduce the ischemia-reperfusion injury of the limb caused by tourniquet.The mechanism may be related to its ability of scavenging oxygen free radicals and downregulating inflammatory factors induced by tourniquet.