止血带应用对下肢手术患者心、肝、肾功能的影响  

Effects of Tourniquet Application on Cardiac,Hepatic and Renal Function in Patients Undergoing Lower Extremity Surgery

作　　者：王良荣[1] 熊响清[1] 金立达[1] 白玉 赵喜越[1] 姚海霞[1] 吉伟[1] 林丽娜[1] 

机构地区：[1]温州医学院附属第一医院麻醉科,325000 [2]郑州大学附属肿瘤医院麻醉科,450000

出　　处：《医学研究杂志》2012年第4期89-91,共3页Journal of Medical Research

基　　金：浙江省中医药科学研究基金资助项目(2010ZA087);浙江省医药卫生科研基金资助项目(2009A143);温州市科委课题资助项目(Y20100025)

摘　　要：目的观察止血带所致的缺血再灌注对下肢手术患者心、肝、肾功能的影响。方法选择美国麻醉医师协会评分Ⅰ～Ⅱ级,年龄25～60岁,止血带充气1.0～1.5h,择期单侧下肢手术病人20例,分别于扎止血带前、扎止血带后1 h、止血带松开后0.5、2、6和24h记录血压、心率,并测定血清戊二醛、白介素-6、白介素-8、一氧化氮、内皮素-1、缺血修饰白蛋白、谷氨酸丙酮酸转氨酶、谷氨酸草酰乙酸转氨酶、胱抑素C和β2-微球蛋白浓度。结果与基础值比较,止血带松开后2～24h患者血清戊二醛、白介素-6、白介素-8、内皮素-1浓度升高,而一氧化氮浓度与一氧化氮/内皮素-1比值下降(P<0.01),各时点血压、心率、血清缺血修饰白蛋白、谷氨酸丙酮酸转氨酶、谷氨酸草酰乙酸转氨酶、胱抑素C和β2-微球蛋白浓度改变均无统计学意义(P>0.05)。结论止血带应用可导致脂质过氧化、全身炎症反应及一氧化氮/内皮素-1失衡,但不影响择期下肢手术患者心、肝、肾功能。Objective To investigate the effect of tourniquet - induced ischemia reperfusion on cardiac, hepatic and renal function in patients undergoing lower extremity surgery. Methods Twenty patients with American Society of Anesthesiology （ASA） physical sta- tus Ⅰ- Ⅱ, aging 25 -60year, tourniquet duration 1.0 - 1.5h, who scheduled for lower extremity surgery were studied. Serum levels of malondialdehyde （ MDA）, interleukin - 6, 8 （ IL - 6, 8 ）, nitric oxide （ NO）, endothelin - 1 （ ET - 1 ）, ischemia modified albumin （IMA） , glutamate pyruvate transaminase （GPT） , glutamate oxaloacetic transaminase （GOT） , cystatin C and β2 - microglobulin were measured just before tourniquet inflation, lh after inflation and 0.5, 2, 6 and 24h after tourniquet deflation. Results In comparison with the baseline values, serum levels of MDA, IL - 6, IL - 8, ET - 1 from 2h to 24h after tourniquet deflation were significantly increased （ P 〈 0.01 ）, while serum NO levels and NO/ET- 1 ratios were decreased. However, no significant changes in blood pressure, heart rate,IMA, GPT, GOT, cystatin C and β2 - microglobulin levels were revealed （P 〉 0.05）. Conclusion Lower limb ischemia - reperfusion associated with the clinical use of a tourniquet could lead to lipid peroxidation, systemic inflammatory response and NO/ET - 1 imbalance, while with little effects on cardiac, hepatic and renal function.

关 键 词：止血带 再灌注损伤 心功能 肝功能 肾功能 

分 类 号：R658.3[医药卫生—外科学]