鞘内注射舒芬太尼对膝关节镜手术缺血再灌注损伤的影响

Effect of intrathecal injection of sufentanil on ischemia-reperfusion injury in knee arthroscopic surgery

目的探讨鞘内注射舒芬太尼对膝关节镜手术缺血再灌注损伤(IRI)的影响。方法选择2019年1月至2020年12月在广西壮族自治区桂东人民医院行单侧膝关节镜外科手术患者60例,随机分为对照组和观察组,每组30例。比较2组止血带充气前(T0)、止血带放气前(T1)、止血带放气后30 min(T2)、止血带放气后24 h(T3)时心率(HR)、收缩压(SDP)、舒张压(DBP)、超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)和白细胞介素6(IL-6)水平变化。结果2组手术时间、止血带充气时间和术中出血量比较,差异无统计学意义(P>0.05)。2组T2、T3时SDP、DBP、HR、SOD、MDA、TNF-α(观察组除外)及IL-6水平均优于T0时,差异有统计学意义(P<0.05)。观察组T2、T3时HR(T3时除外)、SOD、TNF-α及IL-6水平均优于对照组,差异有统计学意义(P<0.05)。结论鞘内注射舒芬太尼可减轻下肢膝关节镜手术使用止血带引起的IRI,对缺血再灌注组织具有保护作用。

Objective To investigate the effect of intrathecal injection of sufentanil on ischemia-reperfusion injury(IRI)in knee arthroscopic surgery.Methods 60 patients who underwent knee arthroscopic surgery in Guidong People′s Hospital of Guangxi Zhuang Autonomous Region from January 2019 to December 2020 were selected and randomly divided into control group and observation group,with 30 cases in each group.The changes of heart rate(HR),systolic blood pressure(SDP),diastolic blood pressure(DBP),superoxide dismutase(SOD),malondialdehyde(MDA),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)levels before tourniquet inflation(T0),before tourniquet deflation(T1),30 min after tourniquet deflation(T2),and 24 h after tourniquet deflation(T3)were compared between the two groups.Results There were no significant differences in operation time,tourniquet inflation time and intraoperative bleeding between the two groups(P>0.05).The levels of SDP,DBP,HR,SOD,MDA,TNF-α(except the observation group)and IL-6 at T2 and T3 in the two groups were better than that at T0,the differences were statistically significant(P<0.05).The levels of HR(except T3),SOD,TNF-αand IL-6 at T2 and T3 in the observation group were better than those in the control group,the differences were statistically significant(P<0.05).Conclusion Internal injection of sufentanil can reduce IRI caused by tourniquet in arthroscopic operation of lower limb and knee,and has a protective effect on ischemia-reperfusion tissue.