摘要
目的观察肢体缺血再灌注损伤后不同指标的水平变化及对肢体缺血再灌注损伤敏感的指标。方法选择20例ASA分级Ⅰ～Ⅱ级患者,择期行单侧下肢手术,分别于上止血带前(T1)、松止血带后5min(T2)、30min(T3)、120min(T4)四个时间点抽取上臂肘正中静脉血,测定血浆丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、一氧化氮(NO)、白细胞介素-8(IL-8)、乳酸脱氢酶(LDH)和肌酸激酶(CK)的血浆浓度。结果四个时间点CK、MDA血浆浓度比较,差异均有统计学意义(F分别=14.39、37.05,P均<0.05),且与T1比较,CK、MDA血浆浓度在T2、T3、T4均明显升高,差异均有统计学意义(t分别=-4.70、-5.45、-5.73;-7.48、-9.69、-8.09,P均<0.05)。TNF-α、IL-8血浆浓度在四个时间点比较,差异有统计学意义(F分别=25.86、30.52,P均<0.05),且与T1比较,在T2时变化无统计学意义(t分别=0.39、-0.48,P均>0.05),在T3、T4明显升高,差异均有统计学意义(t分别=-6.22、-6.65;-6.62、-7.31,P均<0.05)。NO、LDH血浆浓度在各时点变化差异均无统计学意义(F分别=0.30、0.02,P均>0.05)。结论常规使用止血带可诱发肢体缺血再灌注后炎症介质的释放,CK、MDA、TNF-α、IL-8对由止血带诱发的肢体缺血再灌注损伤比NO和LDH更敏感,其中CK、MDA在松止血带5min时就已经升高。
Objective To evaluate the effect of serum changes in malondialdehyde （MDA）, tumor necrosis factor-α （TNF-α）, nitrogen monoxide （NO）, interleukin-8 （IL-8）, creatine kinase （CK） and lactate dehydrogenase （LDH） after is- chemia-reperfusion of lower extremity and seek the sensitive marker of lower extremity ischemia reperfusion injury. Meth- ods Twenty patients matched American society of anesthesiologists physical status Ⅰ - Ⅱ were scheduled for operation of lower extremity. The median cubital vein blood was drawn before tourniquet roped （T1）,after 5 min （T2）, 30 min （T3） and 120 min （T4） of tourniquet loosened. Then the serum concentrations of MDA,TNF-α,NO,IL-8, CK, LDH were measured. Results There were significant differences of plasma CK and MDA concentrations among four time points （F= 14.39,37.05,P〈0.05）. Plasma CK and MDA concentrations were significantly increased at T2,T3 and T4 compared with T1 （t=-4.70,-5.45,-5.73; -7.48,-9.69,-8.09, P〈0.05）. There were significant differences of plasma TNF-α and IL-8 concentrations among four time points（F=25.86,30.52, P〈0.05）. Plasma TNF-α and IL-8 concentrations were not signif- icantly increased at T2 compared with T1 （t=0.39,-0.48, P〉O.05）. Plasma TNF-α and IL-8 concentrations were signifi- cantly increased at T3 and T4 compared with T1 （t=-6.22,-6.65; -6.62,-7.31, P〈0.05）. Plasma NO and LDH concen- trations had no statistical difference among four time points （F=0.30,0.02, P〉0.05 ）. Conclusions Clinical application of tourniquet may lead to limb ischemia reperfusion injury and liberation of inflammatory mediator. The CK, MDA, TNF-α and IL-8 were more sensitive to assess the level of lower extremity ischemia-reperfusion injury than LDH and NO. CK and MDA were increased after 5 min later of tourniquet loosened .
出处
《全科医学临床与教育》
2013年第2期145-147,共3页
Clinical Education of General Practice
基金
杭州市科技局医疗科研及重点专科专题项目(20110833B16)
关键词
缺血再灌注损伤
细胞因子
氧自由基
炎症介质
ischemia reperfusion injury
cytokine
oxygen free radical
inflammatory mediators
