罗库溴铵对膝关节置换术患者肢体缺血再灌注损伤的影响  

Effects of rocuronium on limb ischemia-reperfusion injury in patients undergoing total knee arthroplasty

作　　者：陈慧 周坤鹏 何莹 魏静秋 刘鹤 张月英 Chen Hui;Zhou Kunpeng;He Ying;Wei Jingqiu;Liu He;Zhang Yueying(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院麻醉科,221002

出　　处：《中华麻醉学杂志》2020年第5期543-547,共5页Chinese Journal of Anesthesiology

基　　金：临床技术骨干研修计划(2018211006)。

摘　　要：目的评价罗库溴铵对膝关节置换术患者肢体缺血再灌注损伤的影响。方法选择2019年1月至2019年10月择期拟在全麻下行单侧全膝关节置换术患者90例,年龄50~80岁,ASA分级Ⅰ或Ⅱ级,体重指数<30 kg/cm2。采用随机数字表法分为3组(n=30):生理盐水组(S组)、罗库溴铵0.6 mg/kg组(RL组)和罗库溴铵1.2 mg/kg组(RH组)。静脉注射咪达唑仑、依托咪酯、舒芬太尼和罗库溴铵0.6 mg/kg(RL组)或1.2 mg/kg(RH组)或等容量生理盐水(S组)行麻醉诱导,喉罩置入术后行机械通气,维持PETCO235~45 mmHg。超声引导下行股神经阻滞。吸入1%七氟烷,静脉输注丙泊酚和瑞芬太尼行麻醉维持,术中熵指数40~60。术后采用舒芬太尼行PCIA,维持VAS评分≤4分。VAS评分>4分时,静脉注射氟比洛芬酯100 mg。于止血带充气60 min时取术侧切口边缘股内侧肌肌肉,采用免疫组化法测定骨骼肌抗肌萎缩蛋白表达;分别于止血带充气即刻、充气60 min和放气后5、30 min时采集动脉血样,采用硫代巴比妥酸法测定血清MDA浓度。记录术后48 h内镇痛泵有效按压次数、舒芬太尼用量和氟比洛芬酯用量。记录止血带反应和麻醉恢复期肌松残余的发生情况、术后首次下床时间和术后住院时间。分别于术前和术后24、48 h时测量大腿围,计算术后与术前的差值;记录术后早期(3 d)和远期(3个月)患肢膝关节活动度和止血带相关并发症的发生情况。结果与S组比较,RH组骨骼肌抗肌萎缩蛋白表达上调,止血带放气后30 min时血清MDA浓度降低,术后24和48 h时大腿围差值减小,RH组和RL组术后3 d和3个月时膝关节活动度增加,术后首次下床时间缩短(P<0.05)。与RL组比较,RH组术后3 d和3个月时膝关节活动度增加,术后首次下床时间缩短(P<0.05)。3组止血带反应发生率、术后住院时间、术后镇痛泵有效按压次数、术后舒芬太尼和氟比洛芬酯用量、术后早期和远期止血带相关并发症Objective To evaluate the effects of rocuronium on limb ischemia-reperfusion injury in the patients undergoing total knee arthroplasty.Methods Ninety patients of both sexes,aged 50-80 yr,of American Society of Anesthesiologists physical statusⅠorⅡ,with body mass index<30 kg/cm2,scheduled for elective unilateral knee arthroplasty under general anesthesia combined with femoral nerve block from January 2019 to October 2019,were divided into 3 groups(n=30 each)using a random number table method:normal saline group(group S),rocuronium 0.6 mg/kg group(group RL)and rocuronium 1.2 mg/kg group(group RH).Anesthesia was induced by intravenous injection of midazolam,etomidate,sufentanil and rocuronium 0.6 mg/kg(group RL)or 1.2 mg/kg(group RH)or equal volume of normal saline(group S).Mechanical ventilation was performed after placement of laryngeal mask to maintain PETCO235-45 mmHg.Femoral nerve block was performed under ultrasound guidance.Anesthesia was maintained by inhaling 1%sevoflurane and intravenous infusion of propofol and remifentanil to maintain entropy index at 40-60 during operation.Patient-controlled intravenous analgesia was performed with sufentanil after surgery to maintain visual analogue scale score≤4 points.When visual analogue scale score was>4,flurbiprofen axetil 100 mg was intravenously injected.The vastus medialis muscle at the edge of the incision was obtained at 60 min after inflation to determine the expression of dystrophin by immunohistochemistry.Arterial blood samples were collected immediately after inflation of the tourniquet,at 60 min after inflation,and at 5 and 30 min after deflation for determination of the serum malondialdehyde(MDA)concentrations by the thiobarbituric acid method.The effective pressing times of the analgesic pump and consumption of sufentanil and flurbiprofen axetil were recorded within 48 h after operation.The occurrence of responses to tourniquet and residual muscle relaxation during recovery from anesthesia,the first postoperative off-bed time and postoperative le

关 键 词：雄甾烷醇类 关节成形术 置换 膝 再灌注损伤 四肢 

分 类 号：R687.4[医药卫生—骨科学]