异丙酚对止血带引起的下肢缺血再灌注损伤的影响  

Effect of propofol on tourniquet-induced lower extremity ischemia-reperfusion injury

作　　者：张欢[1] 杨拔贤[1] 于德水[1] 苟淑琴[1] 张秀华[1] 

机构地区：[1]北京大学人民医院麻醉科,100044

出　　处：《中华麻醉学杂志》2001年第9期528-530,共3页Chinese Journal of Anesthesiology

摘　　要：目的　探讨临床剂量异丙酚对止血带引起的下肢缺血再灌注损伤的影响。方法　 19例行双膝关节置换手术病人分为 2组 ,异氟醚组 (I组 ,n =10 ) :咪唑安定 (0 15mg·kg-1) ,维库溴铵(0 1mg·kg-1) ,芬太尼 (3μg·kg-1)诱导插管后吸入异氟醚 (0 8%) ;异丙酚组 (P组 ,n =9) :异丙酚(2mg·kg-1) ,维库溴铵 (0 1mg·kg-1) ,芬太尼 (3μg·kg-1)诱导插管后连续输注异丙酚 (8mg·kg-1·h-1)。两组病人均复合连续硬膜外麻醉。分别于止血带充气前及放气后 5、10、2 0min自股静脉抽血测定血浆肌酸磷酸激酶 (CPK)、乳酸脱氢酶 (LDH) ,丙二醛 (MDA)及血栓素 (TXB2 )、6 酮 前列腺素(6 keto PGF1α)的水平。结果　与止血带充气前相比 ,I组再灌注后 10、2 0minCPK和LDH升高 ,再灌注后 5minMDA升高 (P <0 0 5 ) ;P组再灌注后 5、10、2 0minCPK、MDA无显著性差异 ,10、2 0minLDH降低 (P <0 0 5 ) ,且低于I组相应时间点水平 (P <0 0 5 ) ,再灌注后 5minMDA明显低于I组 (P<0 0 5 ) ;P组 5、10、2 0minTXB2 和 6 keto PGF1α均明显低于 0min及I组相应时间点水平 (P <0 0 5 )。结论　临床剂量输注异丙酚 (8mg·kg-1·h-1)对止血带引起的下肢缺血再灌注损伤有一定的减轻作用 ,表现为脂质过氧化物的清除 。Objective To assess the effect of propofol on changes in plasma enzymes (CPK,LDH), lipid peroxides (MDA) and metabolites of arachidonic acid (TXB 2,6 keto PGF 1α ) after ischemia reperfusion of lower extremity.Methods 19 ASAⅠ Ⅱscheduled for bilateral total knee replacement were randomly allocated to one of the two groups: isoflurane group (group I,n=10) and propoful group(group P, n=9). The patients were premedicated with intramuscular pethidine 50mg and scopolamine 0.3mg 30min before operation. In isoflurane group anesthesia was induced with midazolam 0.15mg·kg -1 ,fentanyl 3μg·kg -1 and vecuronim 0.1mg·kg -1 and maintained with 0.8% isoflurane after tracheal intubation. In propofol group anesthesia was induced with propofol 2mg·kg -1 ,fentanyl 3μg·kg -1 and vecuronim 0.1mg·kg -1 and maintained with propofol infusion 8mg·kg -1 ·h -1 . In both groups general anesthesia was supplemented with epidural block performed at L 2 3 . Blood samples were taken from femoral vein before the tourniquet of right leg was inflated(0min) and 5,10,20min after replace of left leg for determination of plasma creatine phosphokinase(CPK),lactate dehydrogenase(LDH),MDA,TXB 2 and 6 keto PGF 1α levels.Results In group P CPK and LDH levels decreased significantly at 10,20min and MDA level at 5min(P<0.05) whereas there was no significant change in CPK and MDA levels, and LDH decreased signicantly at 10,20min(P<0.05) in group P. MDA level was lower at 5 min in group P than that in group I(P<0.05). TXB 2 and 6 keto PGF 1α levels were lower at 5,10,20 min than the baseline values (0min)in group P and those in group I. Couclusions Propofol infusion 8mg·kg -1 ·h -1 can attenuate tourniquet induced ischemia reperfusion injury of lower extremity. The protective effect is achieved through clearance of lipid peroxides, alleviation of injury degree of skeletal muscle and decreasing TXB 2 level.

关 键 词：二异丙酚 止血带 再灌注损伤 肢体 氧自由基 抗氧化作用 

分 类 号：R614[医药卫生—麻醉学]