不同剂量罗库溴铵对单侧全膝关节置换术中止血带所致肢体缺血―再灌注损伤的影响分析  

Effect of Different Doses of Rocuronium Bromide on Tourniquet-induced Limb Ischemia-reperfusion Injury during Unilateral Total Knee Arthroplasty

作　　者：张鹏 张志军[1] 张明德[1] 刘鹏[1] 景建闯 ZHANG Peng;ZHANG Zhi-jun;ZHANG Ming-de(Anyang People’s Hospital,Anyang,Henan,455000,China)

机构地区：[1]河南省安阳市人民医院,河南安阳455000

出　　处：《黑龙江医学》2022年第15期1826-1829,共4页Heilongjiang Medical Journal

摘　　要：目的:分析不同剂量罗库溴铵对单侧全膝关节置换术(TKA)中止血带所致肢体缺血―再灌注损伤(IRI)的影响。方法:将2019年1月―2020年6月河南省安阳市人民医院收治的行全身麻醉下择期单侧TKA的120例患者作为研究对象,按照随机数表法分为对照组、低剂量组与高剂量组,每组各40例。在麻醉诱导中分别给予患者等容量生理盐水、0.6 mg/kg及1.2 mg/kg的罗库溴铵。记录止血带使用情况、肌松时间、下床时间及住院时间,于止血带充气60 min时检测骨骼肌中抗肌萎缩蛋白(Dys)的表达水平,于血带充气即刻(T0)、充气60 min (T1)和放气后5 min (T2)、30 min (T3)时检测血清丙二醛(MDA)水平,记录术后1 d、2 d时的大腿围差值,记录术后3 d、3个月时的患肢膝关节活动度(ROM),记录术后并发症发生情况。结果:高剂量组的肌松时间(TOF25%时间为与TOF90%时间)均明显长于低剂量组。高剂量组的Dys水平明显高于对照组。T3时,高剂量组的血清MDA水平明显低于对照组;术后2 d时,高剂量组的大腿围差值明显小于对照组;术后3 d及3个月时,高剂量组与低剂量组的ROM均明显大于对照组,高剂量的ROM明显大于低剂量组;高剂量组与低剂量组的下床时间均明显短于对照组,高剂量的下床时间明显短于低剂量组。结论:高剂量(1.2 mg/kg)的罗库溴铵能够减轻单侧TKA中止血带所致肢体IRI。Objective: To analyze the effects of different doses of rocuronium bromide on tourniquet-induced ischemia-reperfusion injury(IRI) in unilateral total knee arthroplasty(TKA). Methods: A total of 120 patients with elective unilateral TKA under general anesthesia admitted to the hospital from January 2019 to June 2020 were selected as the research subjects and divided into control group, low-dose group and high-dose group according to the random number table method, with 40 cases in each group.During induction of anesthesia, patients were given equal volume of normal saline, 0.6 mg/kg and 1.2 mg/kg of rocuronium bromide, respectively. The tourniquet usage, muscle relaxant time, time of getting out of bed and hospital stays were recorded. The expression level of dystrophin(Dys) in skeletal muscle was detected when the tourniquet was inflated for 60 min. Serum levels of malondialdehyde(MDA) were detected immediately after inflation(T0), 60 min after inflation(T1), 5 minutes(T2) and 30 min(T3) after deflation. The difference of thigh circumference was recorded at 1 d, 2 d after surgery. The range of motion(ROM) of affected knee was recorded at 3 d and 3 months after surgery. The postoperative complications were recorded. Results: The muscle relaxation time(TOF25% time and TOF90% time) in the high-dose group was significantly longer than that in the low-dose group. The Dys level in the high-dose group was significantly higher than that in the control group. At T3, the serum MDA level in the high-dose group was significantly lower than that in the control group. At 2 days after operation, the thigh circumference difference of the high-dose group was significantly smaller than that of the control group. At 3 days and 3 months after operation, the ROM of the high-dose group and the low-dose group was significantly greater than that of the control group. The ROM of the high-dose group was significantly greater than that of the low-dose group. The time to get out of bed in the high-dose group and the low-dose group was signi

关 键 词：全膝关节置换术 全身麻醉 罗库溴铵 止血带 缺血—再灌注损伤 

分 类 号：R734.2[医药卫生—肿瘤]