肢体缺血再灌注损伤评价指标的临床观察  

The Observation of Evaluation Standard for Ischemic Reperfusion of limbs

作　　者：方剑[1] 李涛[1] 刘克明[1] 马少云[1] 刘志龙[1] 方小萍[1] 

机构地区：[1]广东省中医院珠海医院,珠海市519015

出　　处：《麻醉与监护论坛》2006年第2期71-72,共2页Forum of Anesthesia and Monitoring

摘　　要：目的：观察分析临床上肢体缺血再灌注损伤的评价指标，为相关研究提供临床参考。 方法：选择骨科下肢手术需上止血带患者40例，于患肢止血带远端在消毒铺巾后无菌条件下，以20G静脉留置针开放一条静脉通路，用于给药及血样采集。40例患者随机分为两组。局部静脉用川芎嗪组20例（Ⅰ组）。局部静脉用生理盐水组20例（Ⅱ组）。两组分别在缺血前（止血带充气前）5min，缺血后再灌注前（止血带放气0-1min内），再灌注后15min及30min等各时点，监测缺血再灌注患肢静脉血中的MDA，LDH，CK的水平。 结果：Ⅱ组缺血再灌注后15min及30min的MDA与缺血前比明显升高（P〈0.05，Ⅰ组缺血再灌注后15min及30min的MDA与缺血前比明显降低（P〈0.05）。Ⅱ组缺血再灌注后15min及30min的LDH，CK与缺血前比略有降低，但无显著意义（P〉0.05）。 结论：本研究中的的MDA较好地反映肢体缺血再灌注损伤的实际情况，LDH，CK则未能有效地反映肢体缺血再灌注损伤程度，与其它类似的研究结果有所不同。以LDH，CK作为肢体缺血再灌注损伤的评价指标值得进一步讨论。Objectice： TO analyze the evatuation standard of ischemic reperfusion of limbs. Methods 40 cases of orthopedic patients with lower limb operations, In whom tourniquets were applied for 80 - 90 minutes. Venous pathways were set distal to tourniquet for blood samples and intravenous administration. All the cases were randomly divided into 2 groups： 2O cases in group Ⅰ（local intravenous chuanxiongzine administration）, 20 cases in group Ⅱ （0.9% saline control） Blood samples were obtained 5 rnln before fastening tourniquet, and 1 and 15 and 30 minutes after release of tourniquet. The MDA, LOH, CK were measured and compared. Result; MDA after 15 and 30 minutes of reperfusion in group Ⅱ is significantly higher than 5 min before ischemia （P〈0.05）. LDH and CK after 15 and 30 minutes of feperfusion in group Ⅱ are slightly less than 5 min before ischemia but no significance （P〉0.05）. Conctusion： MDA properly represents the evaluation standard of ischemic repeffusion of limbs LDH and CK can not effectivly reflect the degree of ischemical reperfusion injury in limbs. It is a question that LDH and CK as the evaluation standard for ischemic repetfusion of limbs.

关 键 词：肢体 缺血再灌注 评价标准 

分 类 号：R654.3[医药卫生—外科学] R174.4[医药卫生—临床医学]