羟乙基淀粉对下肢缺血再灌注引起的炎症反应的影响  

Effects of hydroxyethyl starch on systemic inflammatory response induced by lower extremity ischemiareperfusion.

作　　者：于泳浩[1] 张素品[1] 李清[1] 

机构地区：[1]天津医科大学总医院麻醉科,300052

出　　处：《中国医药》2009年第10期790-791,共2页China Medicine

摘　　要：目的观察输注羟乙基淀粉130／0．4对下肢止血带释放后引起缺血再灌注致内皮细胞功能及全身炎症反应的影响。方法40例下肢手术患者用随机数字法分为羟乙基淀粉组和对照组，各20例。采用单盲法观察。羟乙基淀粉组输注羟乙基淀粉130／0．4，对照组输注乳酸钠林格液。除上述液体外，2组均于相同静脉同时输注乳酸钠林格液。在松止血带前后不同时间点采取尿和血标本测定尿微量白蛋白／肌酐（A／C）比值和血白细胞介素_6、可溶性黏附分子水平。结果羟乙基淀粉组患者围术期晶体输入量明显低于对照组，差异有统计学意义（P〈0．05）。2组尿A／C比值在松止血带后均明显升高，至12h后恢复基础水平，其中在松止血带后15rain、4h羟乙基淀粉组明显低于对照组，差异有统计学意义（P〈0．05）。2组血IL-6水平在松止血带后各时点均明显高于基础值，羟乙基淀粉组低于对照组，差异有统计学意义（P〈0．05）。对照组血sICAM-1水平在松止血带后4h、12h明显高于基础值，而羟乙基淀粉组在没有明显改变。组间差异有统计学意义（P〈0．05）。结论使用羟乙基淀粉130／0．4可减轻下肢缺血再灌注损伤引起的毛细血管通透性增加，抑制过度的炎症反应和内皮细胞功能障碍。Objective To observe the effects of hydroxyethy starch（HES） 130/0.4 on endothelial cell func- tion and systemic inflammatory response induced by lower limb ischemia-reperfusion injury after tourniquet release. Methods Forty patients scheduled for elective lower limb surgery were respectively infused some volume of HES130/0.4（n = 10, HES group）or lactated Ringer＇s solution （n = 10, Control group）, then all recieved lactated Ringer＇s solution. Microalbuminuria to creatinine ratio （A/C）, serum concentration of interleukin-6 （IL-6） and soluble intercellular adhesion molecule-1 （slCAM-1）were analyzed after epidural anesthesia and at 15 min,4 hr and 12 hr after tourniquet release. Results Compared with the baseline level, A/C ratio and IL-6 were higher in HES group and Control group. Meanwhile A/C ratio and IL-6 in HES group were much lower than those in control group. The slCAM-1 in control group was obviously higher than the baseline. Conclusion HES130/0.4 can significantly hinder the increasement of capillary permeability caused by lower limb ischemia-reperfusion and inhibit the excess inflammatory response and the dysfunction of endothelial cell.

关 键 词：羟乙基淀粉 内皮细胞 可溶性黏附分子 

分 类 号：R364.1[医药卫生—病理学]