缺血预适应对游离皮瓣围术期缺血再灌注保护作用的研究  

Research on the protective effect of ischemic preconditioning on ischemic reperfusion of free flap during perioperative period

作　　者：马超[1,2] 曲彦亮 武春敏 温宝磊 张欣 陈付强 Ma Chao;Qu Yanliang;Wu Chunmin;Wen Baolei;Zhang Xin;Chen Fuqiang(Department of Pain Control,Municipal State Hospital Affiliated to Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属青岛市市立医院疼痛科,山东青岛266000 [2]解放军第九七一医院手外麻醉科

出　　处：《海军医学杂志》2019年第2期163-165,共3页Journal of Navy Medicine

摘　　要：目的探讨分析缺血预适应对游离皮瓣围术期缺血再灌注的保护作用。方法选择我院2017年10月至2018年6月收治的40例臂丛神经阻滞+腰硬联合麻醉下行择期上肢游离皮瓣术患者作为研究对象,采用随机数字法将其分成预适应组和对照组。2组患者均进行常规术侧肢体束扎自动充气止血带,预适应组在束扎止血带前进行缺血预适应,对照组不进行任何操作。手术均由相同资质的手术医生完成,术后用药及康复治疗方案一致。比较2组患者术前(T_0)、皮瓣通血后15 min(T_1)、术后6 h(T_2)、术后12 h(T_3)时血浆丙二醛(MDA)、超氧化物歧化酶(SOD)含量并记录术后血管危象发生次数、探查次数及皮瓣成活情况。结果与T_0比较,对照组T_1、T_2、T_3时MDA水平显著升高,SOD水平显著降低,差异有统计学意义(P<0.05);与对照组比较,预适应组T_1、T_2、T_3时相对应MDA水平升高、SOD水平降低,差异无统计学意义(P>0.05);预适应组血管危象次数及探查次数低于对照组,皮瓣完全成活率高于对照组,差异无统计学意义(P>0.05)。结论缺血预适应能够提高游离皮瓣对缺血再灌注损伤的保护,具有较好的临床效果,值得推广应用。Objective To investigate the protective effect of ischemic preconditioning on ischemic reperfusion of free flap during perioperative period.Methods Forty patients admitted to the hospital from October 2017 to June 2018 to have upper limb free flap surgery with brachial plexus nerve block combined with spinal epidural anesthesia were selected as study subjects, and were randomly divided into the preconditioning group and the control group. Patients in both groups received conventional surgical side limb ligation automatic inflatable tourniquet. The preconditioning group underwent ischemic preconditioning before the ligation of the tourniquet, while the control group was left there intact. All the operations were performed by surgeons with the same qualification, and medication after surgery and rehabilitation treatment were identical in both groups. The contents of malondialdehyde (MDA) and superoxide dismutase (SOD) respectively at time 0 (T0), at 15 min (T1) after blood flow through the skin flap, at 6 h (T2) and 12h (T3) after surgery were compared between the 2 groups, and the rate of vascular crisis, the number of probes and survival rate of skin flaps were recorded. Results Compared with T0, MDA levels of the control group at T1, T2 and T3 were significantly increased and SOD level was decreased markedly( P <0.05). As compared with the control group, MDA levels of the preconditioning group at T1, T2 and T3 were increased, while SOD levels were decreased. However, no statistical significance could be seen when comparisons were made between them( P <0.05). The rate of vascular crisis and probing in the preconditioning group was lower than that in the control group, and the survival rate of skin flaps was higher than that in the control group, but without statistical significance ( P <0.05). Conclusion Ischemic preconditioning could enhance the protection of free flaps against ischemic-reperfusion injury, with good clinical effects. For this reason, it is worth further clinical extension.

关 键 词：缺血预适应 游离皮瓣移植术 缺血再灌注损伤 臂丛神经阻滞 腰硬联合麻醉 

分 类 号：R64[医药卫生—外科学]