尼可地尔对全膝关节置换术患者肢体缺血再灌注损伤指标的影响  

Effect of nicorandil on indexes related to limb ischemia-reperfusion injury in patients undergoing total knee arthroplasty

作　　者：张春燕[1] 姚菊[2] 孟蓓[2] 范震宇[1] 陈伯华[1] ZHANG Chun-yan;YAO Ju;MENG Bei;FAN Zhen-yu;Chen Bo-hua(Department of Pharmacy,Affiliated Hospital of Nantong University,Nantong 226001,China;Department of Anesthesiology and Operating Theater,Affiliated Hospital of Nantong University,Nantong 226001,China)

机构地区：[1]南通大学附属医院药学部,江苏省南通市226001 [2]南通大学附属医院麻醉手术科,江苏省南通市226001

出　　处：《广西医学》2021年第15期1822-1824,共3页Guangxi Medical Journal

基　　金：江苏省药学会-天晴医院药学科研项目(Q2019162)。

摘　　要：目的探讨尼可地尔对全膝关节置换术(TKA)患者肢体缺血再灌注损伤相关指标的影响。方法将40例择期行TKA的患者随机分为对照组与尼可地尔组,各20例。两组患者均在常规硬膜外阻滞麻醉后行TKA,术中使用止血带。于术前0.5 h,分别给予对照组、尼可地尔组患者以80μg/(kg·h)的速率静脉泵注生理盐水、尼可地尔,直至手术结束。于手术前5 min(T_(0))、松止血带后20 min(T_(1)),检测患者外周血丙二醛、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平。结果与T_(0)时比较,T_(1)时对照组丙二醛、TNF-α、IL-6水平均升高(均P<0.05),而尼可地尔组上述指标的变化差异无统计学意义(均P>0.05);T_(1)时,尼可地尔组的丙二醛、TNF-α、IL-6水平均低于对照组(均P<0.05)。结论术前和术中使用尼可地尔,或可通过减轻细胞脂质过氧化、减少炎性细胞因子释放,抑制TKA中使用止血带引起的肢体缺血再灌注损伤。Objective To explore the effect of nicorandil on indexes related to limb ischemia-reperfusion injury in patients undergoing total knee arthroplasty(TKA).Methods Forty patients undergoing selective TKA were randomized to control group(n=20)or nicorandil group(n=20).Patients of both groups received TKA after conventional epidural block anesthesia,and tourniquet was applied to TKA intraoperatively.From half an hour before operation,intravenous infusion of normal saline and nicorandil was performed on patients of the control and nicorandil groups respectively,with an infusion speed of 80μg/(kg·h),until the end of operation.Five minutes before operation(T_(0))and 20 minutes after unclasping tourniquet(T_(1)),peripheral blood levels of malondialdehyde,interleukin 6(IL-6)and tumor necrosis factor alpha(TNF-α)were determined in all patients.Results In the control group,the levels of malondialdehyde,TNF-αand IL-6 were increased at T_(1)than those at T_(0)(all P<0.05),while variants in the aforementioned indexes in the nicorandil group showed no statistically significant difference(all P>0.05);at T_(1),the nicorandil group exhibited lower levels of malondialdehyde,TNF-αand IL-6 than the control group(all P<0.05).Conclusion Preoperative and intraoperative administration of nicorandil can inhibit limb ischemia-reperfusion injury due to tourniquet use during TKA probably by alleviating cell lipid peroxidation and reducing the release of inflammatory cytokines.

关 键 词：全膝关节置换术 缺血再灌注损伤 止血带 尼可地尔 白细胞介素6 肿瘤坏死因子Α 丙二醛 

分 类 号：R658.3[医药卫生—外科学]