摘要
目的观察老年患者膝关节置换术后心肺功能的变化,并探索缺血预处理及乌司他丁静脉输注对其影响。方法选择2012年11月至2018年5月本院关节外科硬膜外联合蛛网膜下腔麻醉下单侧膝关节置换术老年患者45例,采用随机数字表法分为对照组(C组,n=15)、下肢缺血预处理组(IP组,n=15)和乌司他丁组(U组,n=15)。C组:常规麻醉管理;IP组:于术前对术肢止血带加压至480 mmHg,5 min后开放止血带,循环3次后开始手术;U组:于麻醉后20 min内静注乌司他丁20万单位,之后20单位/(kg·min)缓慢泵注直至手术结束。3组分别于术肢止血带松开前5 min(T0)、止血带松开后1 h(T1)、6 h(T2)、24 h(T3)抽取桡(股)动脉血,测定心肌酶谱(CK、CKMB、LDH)、血气分析(RI、cLac)、炎症细胞因子(TNF-α、IL-1、IL-6)、丙二醛(MDA)和黄嘌呤氧化酶(XOD)等。结果与T0相比,C组患者CK在T2、T3显著升高(P<0.05),RI在T1、T2显著增高(P<0.05),cLac、OXD在T2显著增高(P<0.05);与C组比较,IP组患者CK、RI、cLac、XOD在T2显著降低(P<0.05),U组显示出下调的趋势,但差异无统计学意义(P>0.05)。各组CKMB、LDH、TNF-α、IL-1、IL-6及MDA组内及组间差异无统计学意义(P>0.05)。结论膝关节置换术后老年患者心功能变化不大,肺功能可能不同程度受损,其原因在于氧化应激反应而不是系统性炎症反应;下肢缺血预处理可通过抑制氧化应激改善其肺功能。
Objective To observe the changes of cardiopulmonary function in elderly patients undergoing unilateral knee arthroplasty, and to explore the effects of ischemic preconditioning and ulinastatin infusion on them. Methods A total of 45 elderly patients undergoing knee arthroplasty under epidural combined subarachnoid anesthesia in our hospital from November 2012 to May 2018 were prospectively recruited in this study. They were randomly divided into control group(Group C, n=15, routine anesthesia management), limb ischemic preconditioning group(Group IP, n=15, the tourniquet pressurized to 480 mmHg followed by being opened 5 min later, 3 cycles before surgery) and ulinastati infusion group [Group U, n=15, venous infusion of 200 kU ulinastatin within 20 min after anesthesia, then continuously pumping at 20 U/(kg·min) until the end of surgery]. Iliac(femoral) arterial blood samples were collected at 5 min before(T0) and 1(T1), 6(T2) and 24 h(T3) after tourniquets were relaxed. Myocardial enzymes detection(CK, CKMB, LDH), blood gas analysis [respiratory index(RI), lactic acid(cLac)], inflammatory cytokines(TNF-α, IL-1, IL-6), malondialdehyde(MDA) and xanthine oxidase(XOD) measurement were carried out respectively. Results In Group C, CK were significantly increased at T2 and T3(P<0.05), RI remarkably rose at T1 and T2(P<0.05), cLac and OXD also elevated notably at T2(P<0.05) when compared with the levels at T0. These markers were significantly reduced in Group IP at T2(P<0.05) and tended to decline in Group U at the above time points(P>0.05). There were no obvious differences in the levels of CKMB, LDH, TNF-α, IL-1, IL-6 and MDA in intra-or inter-groups(P>0.05). Conclusion For the elderly patients undergoing knee arthroplasty, no significant changes are seen in cardiac function, but their pulmonary function may be impaired at different degrees due to oxidative stress instead of systemic inflammatory reaction. Lower limb ischemic preconditioning can improve pulmonary function by inhibiting oxidative stress.
作者
卢孙山
陈星同
何心海
田国平
吕锐
曹剑
易斌
甯交琳
鲁开智
顾健腾
LU Sunshan;CHEN Xingtong;HE Xinhai;TIAN Guoping;LYU Rui;CAO Jian;YI Bin;NING Jiaolin;LU Kaizhi;GU Jianteng(Department of Anesthesiology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038,China)
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2019年第21期2094-2100,共7页
Journal of Third Military Medical University
基金
陆军军医大学第一附属医院临床科研基金(SWH2016LCYB-18)~~
关键词
老年人
膝关节置换术
心肺功能
缺血预处理
乌司他丁
aged
knee arthroplasty
cardiopulmonary function
ischemic preconditioning
ulinastatin
