磷酸肌酸钠预注射对全膝关节置换术病人骨骼肌缺血再灌注损伤的影响
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摘要
目的探讨磷酸肌酸钠预注射对全膝关节置换术(total knee arthroplasty, TKA)病人骨骼肌缺血再灌注损伤(ischemia reperfusion injury, IRI)的影响。方法选取2016年6月至2017年6月于常州市中医医院择期行初次单侧TKA的病人70例,随机分为磷酸肌酸钠组和对照组,各35例。磷酸肌酸钠组在上止血带前30 min静脉滴注磷酸肌酸钠30 mg/kg(溶于100 ml生理盐水),输注时间为30 min。对照组注射等量的生理盐水。记录并比较两组病人手术开始时、松止血带即刻、松止血带后30 min、松止血带后1 h这4个时间点的血清白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、白细胞介素8(IL-8)、丙二醛(MDA)、肿瘤坏死因子α(TNF-α)、乳酸脱氢酶(LDH)、超氧化物歧化酶(SOD)水平;记录病人术后1、3、7 d时患肢根部的疼痛视觉模拟量表(visual analogue scale, VAS)评分。结果与手术开始时的各指标数值相比,松止血带即刻、松止血带后30 min、松止血带后1 h时两组的IL-1β、IL-6、IL-8、MDA、TNF-α、LDH水平均显著升高,而SOD水平显著降低;而且,除松止血带后的IL-8水平,磷酸肌酸钠组各观察时间点IL-1β、IL-6、IL-8、MDA、TNF-α、LDH的数值均显著低于对照组,而SOD水平显著高于对照组;术后磷酸肌酸钠组患肢根部的VAS评分明显小于对照组。上述指标比较,差异均有统计学意义(P均<0.05)。结论磷酸肌酸钠预注射可预防TKA术后病人骨骼肌IRI,可用于改善术后止血带反应。
Objective To investigate the effect of pre-injection of sodium creatine phosphate onskeletal muscle ischemia-reperfusion injury(IRI) after total knee arthroplasty(TKA). Methods From June2016 to June 2017, 70 patients with primary unilateral TKA were selected from Changzhou Traditional ChineseMedicine Hospital. They were randomly divided into experimental group and control group. In the experimentalgroup, intravenous sodium creatine phosphate 30 mg/kg(dissolved in 100 ml physiological saline) was infused30 min before the upper tourniquet, and the infusion time was 30 min. The control group was injected with anequal amount of physiological saline. The serum interleukin-1β(IL-1β), IL-6, and IL-8, malondialdehyde(MDA), serum tumor necrosis factor(TNF)-α, lactate dehydrogenase(LDH), superoxide dismutase(SOD) at thebeginning of surgery, and immediate, 30 min and 1 h after loosing tourniquet were determined and comparedbetween two groups. The visual analogue scale(VAS) scores were recorded at 1st, 3rd and 7th day afteroperation. Results Compared with the beginning of the operation, the level of IL-1β, IL-6, IL-8, MDA, TNF-α, LDH was significantly increased, and the SOD was significantly decreased immediate, 30 min, and 1 h afterloosing tourniquet. Compared with the control group, except for the level of IL-8 after loosing tourniquet, IL-1β,IL-6, IL-8, MPA, TNF-α and LDH levels in experimental group at all time points decreased significantly, whileSOD increased significantly(P<0.05 for all). The VAS score of the root in the experimental group wassignificantly lower than that in the control group(P<0.05). Conclusion Sodium creatine phosphate pre-injection has protective effect on skeletal muscle IRI after TKA and can be used to prevent postoperativetourniquet response.
Objective To investigate the effect of pre-injection of sodium creatine phosphate onskeletal muscle ischemia-reperfusion injury(IRI) after total knee arthroplasty(TKA). Methods From June2016 to June 2017, 70 patients with primary unilateral TKA were selected from Changzhou Traditional ChineseMedicine Hospital. They were randomly divided into experimental group and control group. In the experimentalgroup, intravenous sodium creatine phosphate 30 mg/kg(dissolved in 100 ml physiological saline) was infused30 min before the upper tourniquet, and the infusion time was 30 min. The control group was injected with anequal amount of physiological saline. The serum interleukin-1β(IL-1β), IL-6, and IL-8, malondialdehyde(MDA), serum tumor necrosis factor(TNF)-α, lactate dehydrogenase(LDH), superoxide dismutase(SOD) at thebeginning of surgery, and immediate, 30 min and 1 h after loosing tourniquet were determined and comparedbetween two groups. The visual analogue scale(VAS) scores were recorded at 1st, 3rd and 7th day afteroperation. Results Compared with the beginning of the operation, the level of IL-1β, IL-6, IL-8, MDA, TNF-α, LDH was significantly increased, and the SOD was significantly decreased immediate, 30 min, and 1 h afterloosing tourniquet. Compared with the control group, except for the level of IL-8 after loosing tourniquet, IL-1β,IL-6, IL-8, MPA, TNF-α and LDH levels in experimental group at all time points decreased significantly, whileSOD increased significantly(P<0.05 for all). The VAS score of the root in the experimental group wassignificantly lower than that in the control group(P<0.05). Conclusion Sodium creatine phosphate pre-injection has protective effect on skeletal muscle IRI after TKA and can be used to prevent postoperativetourniquet response.
引文
[1]蒲川成,冉学军,覃勇志,等.同期和分期全膝关节置换术治疗双侧膝骨关节炎的比较[J].骨科, 2017, 8(4):278-282.
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[8]雷震.磷酸肌酸钠对骨科全麻应用止血带患者的血流动力学影响[J].中南医学科学杂志, 2017, 45(5):509-512.
[9]Sacks JM, Kuo YR, Horibe EK, et al. An optimized dual-surgeonsimultaneous orthotopic hind-limb allotransplantation model inrats[J]. J Reconstr Microsurg, 2012, 28(1):69-75.
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[11]Lowrie AG, Berry MG, Kirkpatrick JJ, et al. Arterial injuries at theelbow carry a high risk of muscle necrosis and warrant urgentrevascularisation[J]. Ann R Coll Surg Engl, 2012, 94(2):124-128.
[12]喻文立,杜洪印,翁亦齐.磷酸肌酸钠对活体肝移植术病人围术期心肌损伤的影响[J].中华麻醉学杂志, 2010, 30(12):1424-1427.
[13]Ito Y, Kaneko N, Iwasaki T, et al. IL-1βas a target in inflamma-tion[J]. Endocr Metzab Immune Disord Drug Targets, 2015, 15(3):206-211.
[14]宋书田,张彬,张楠,等.曲美他嗪对非体外循环冠脉搭桥术患者IL-6、IL-8的影响[J].中华心脏与心律电子杂志, 2016, 4(4):20-208.
[15]肖玮,魏智蕙,高建华.右美托咪定股神经阻滞对TKA术后镇痛的影响[J].西南国防医药, 2015, 25(4):415-417.
[16]王卓强,魏昌伟,马超.右美托咪定对重症肌无力患者围术期血流动力学及苏醒质量的影响[J].临床麻醉学杂志, 2015, 31(6):543-545.
[17]温红娟,祝恩智,阚俊明,等.仙茅提取物对局灶性脑缺血损伤大鼠的保护作用[J].中华中医药杂志, 2018, 33(5):2028-2030.
[18]何荷番,刘炜烽,刘义彬,等.右美托咪定复合地佐辛用于老年患者纤维支气管镜引导清醒气管插管术的辅助效果[J].中华麻醉学杂志, 2015, 35(1):76-79.
[19]包音,李天佐.腰丛联合坐骨神经阻滞下足踝手术患者右美托咪定和丙泊酚粑控输注镇静效果的比较[J].北京医学, 2013,35(8):625-628.
[20]邓小强,陈珂,姜徽,等.磷酸肌酸钠预先给药对2型糖尿病患者心肌缺血再灌注损伤的影响[J].临床麻醉学杂志, 2015, 31(1):9-11.
[21]Abo-Alhol TR, Fitzpatrick CK, Clary CW, et al. Patellar me-chanics during simulated kneeling in the natural and implantedknee[J]. J Biomech, 2014, 47(5):1045-1051.
[22]丁明,李大鹏,王昕辉,等.外源性磷酸肌酸钠对缺血再灌注骨骼肌保护机制的实验研究[J].实用医药杂志, 2012, 29(7):627-629, 633.
[23]吴静,疏树华,柴小青,等.磷酸肌酸钠预处理对老年患者全膝关节置换骨水泥植入术中循环功能的保护作用[J].临床麻醉学杂志, 2015, 31(12):1186-1189.
[24]高晶,周伟,吕国义.磷酸肌酸钠对老年全麻患者术后认知功能的影响[J].中国老年学杂志, 2012, 32(20):4407-4408.
[25]何燕,周继春,徐晓月.注射用磷酸肌酸钠的安全性评价[J].中国医院药学杂志, 2011, 31(22):1871-1874.
[2]Muyskens JB, Hocker AD, Turnbull DW, et al. Transcriptionalprofiling and muscle cross-section analysis reveal signs of isch-emia reperfusion injury following total knee arthroplasty with tour-niquet[J]. Physiol Rep, 2016, 4(1):e12671.
[3]王宇,崔宇,刘斌.七氟醚和异丙酚对骨科手术患者止血带诱发肢体缺血再灌注损伤影响的比较[J].中华麻醉学杂志, 2012,32(10):1189-1191.
[4]李明哲,张海龙.右美托咪定减轻全膝关节置换术后止血带性缺血-再灌注损伤效果观察[J].人民军医, 2017, 60(4):361-364.
[5]徐阳,罗辉宇,张振.瑞芬太尼对止血带引起肢体缺血再灌注损伤的影响[J].现代中西医结合杂志, 2015, 24(8):886-888.
[6]Deng KW, Shi XB, Zhao YX, et al. The effect of exogenous cre-atine phosphate on myocardial injury after percutaneous coronaryintervention[J]. Angiology, 2015, 66(2):163-168.
[7]谷雷,陈珂,徐慧琴,等.磷酸肌酸钠预先给药对膝关节镜手术病人下肢骨骼肌缺血再灌注损伤的影响[J].安徽医科大学学报, 2015, 50(12):1799-1801.
[8]雷震.磷酸肌酸钠对骨科全麻应用止血带患者的血流动力学影响[J].中南医学科学杂志, 2017, 45(5):509-512.
[9]Sacks JM, Kuo YR, Horibe EK, et al. An optimized dual-surgeonsimultaneous orthotopic hind-limb allotransplantation model inrats[J]. J Reconstr Microsurg, 2012, 28(1):69-75.
[10]Codding JL, Vosbikian MM, llyas AM, et al. Acute CompartmentSyndrome of the hand[J]. Hand Surg Am, 2015, 40(6):1213-1216.
[11]Lowrie AG, Berry MG, Kirkpatrick JJ, et al. Arterial injuries at theelbow carry a high risk of muscle necrosis and warrant urgentrevascularisation[J]. Ann R Coll Surg Engl, 2012, 94(2):124-128.
[12]喻文立,杜洪印,翁亦齐.磷酸肌酸钠对活体肝移植术病人围术期心肌损伤的影响[J].中华麻醉学杂志, 2010, 30(12):1424-1427.
[13]Ito Y, Kaneko N, Iwasaki T, et al. IL-1βas a target in inflamma-tion[J]. Endocr Metzab Immune Disord Drug Targets, 2015, 15(3):206-211.
[14]宋书田,张彬,张楠,等.曲美他嗪对非体外循环冠脉搭桥术患者IL-6、IL-8的影响[J].中华心脏与心律电子杂志, 2016, 4(4):20-208.
[15]肖玮,魏智蕙,高建华.右美托咪定股神经阻滞对TKA术后镇痛的影响[J].西南国防医药, 2015, 25(4):415-417.
[16]王卓强,魏昌伟,马超.右美托咪定对重症肌无力患者围术期血流动力学及苏醒质量的影响[J].临床麻醉学杂志, 2015, 31(6):543-545.
[17]温红娟,祝恩智,阚俊明,等.仙茅提取物对局灶性脑缺血损伤大鼠的保护作用[J].中华中医药杂志, 2018, 33(5):2028-2030.
[18]何荷番,刘炜烽,刘义彬,等.右美托咪定复合地佐辛用于老年患者纤维支气管镜引导清醒气管插管术的辅助效果[J].中华麻醉学杂志, 2015, 35(1):76-79.
[19]包音,李天佐.腰丛联合坐骨神经阻滞下足踝手术患者右美托咪定和丙泊酚粑控输注镇静效果的比较[J].北京医学, 2013,35(8):625-628.
[20]邓小强,陈珂,姜徽,等.磷酸肌酸钠预先给药对2型糖尿病患者心肌缺血再灌注损伤的影响[J].临床麻醉学杂志, 2015, 31(1):9-11.
[21]Abo-Alhol TR, Fitzpatrick CK, Clary CW, et al. Patellar me-chanics during simulated kneeling in the natural and implantedknee[J]. J Biomech, 2014, 47(5):1045-1051.
[22]丁明,李大鹏,王昕辉,等.外源性磷酸肌酸钠对缺血再灌注骨骼肌保护机制的实验研究[J].实用医药杂志, 2012, 29(7):627-629, 633.
[23]吴静,疏树华,柴小青,等.磷酸肌酸钠预处理对老年患者全膝关节置换骨水泥植入术中循环功能的保护作用[J].临床麻醉学杂志, 2015, 31(12):1186-1189.
[24]高晶,周伟,吕国义.磷酸肌酸钠对老年全麻患者术后认知功能的影响[J].中国老年学杂志, 2012, 32(20):4407-4408.
[25]何燕,周继春,徐晓月.注射用磷酸肌酸钠的安全性评价[J].中国医院药学杂志, 2011, 31(22):1871-1874.
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