七氟醚预处理对全膝关节置换术后止血带性缺血再灌注损伤的影响

摘要

Objective: To investigate the effect of sevoflurane preconditioning on tourniquet ischemia reperfusion injury in patients undergoing total knee arthroplasty.Methods:Thirty patients who were performed first time TKA on unilateral knee were randomly divided into 2 groups(n=15 each),control group(group B)and experimental group(group A),Group A inhaled sevoflurane with the end-tidal concentration corresponding to 1MAC for 30min before use of tourniquet, while in group B,the patients inhaled only 100,O2. Serum MDA and SOD were assayed respectively before induction of anesthesia (T0) and 30 min (T1),60 min(T2) after reperfusion. Pathological changes in the quadriceps muscle were compared between the 2 groups through biopsy.Results:When compared with T0,the concentrations of MDA in both groups were significantly increased at T1,T2(P<0.05),while the expression of SOD in two groups were decreased significantly(P<0.05).The concentrations of MAD in group A were decreased significantly at T1,T2(P<0.05 orP<0.01)when compared with those in group B.The activity of SOD in group A was significantly increased at T1 and T2(P<0.05).The biopsy showed dissolved quadriceps and massive neutrophil infiltration in group B but normal muscle tissue in group A.Conclusion:Sevoflurane preconditioning can reduce a tourniquet-induced lower extremity ischemia-reperfusion injury . It may protect the skeletal muscle from the injury during use of tourniquet and improve the early recovery quality in patients undergoing total knee arthroplasty.%目的：评价七氟醚预处理对全膝关节置换术后止血带性缺血再灌注损伤的影响。方法：择期在全麻下拟行单侧全膝关节置换术(TKA)的患者30例，随机分为2组(n=15)：实验组(A组)和对照组(B组)。A组于止血带充气前吸入1MAC七氟醚30min，B组患者只吸入纯氧。测定并比较两组患者麻醉诱导前(T0)和止血带放气后30min(T1)、60min(T2)时的超氧化物歧化酶(SOD)活性及丙二醛(MDA)浓度，术后取股四头肌活检观测肌肉的病理改变。结果：T1、T2时两组MDA浓度明显高于T0时而SOD活性明显低于T0时，(P＜0.05)；A组于T1、T2时MDA浓度显著低于B组而SOD活性显著高于B组(P＜0.05或P＜0.01)；B组病理切片示股四头肌溶解，大量中性粒细胞浸润；A组为正常肌肉组织。结论：七氟醚预处理可减轻TKA手术患者止血带诱发下肢缺血再灌注损伤，对骨骼肌有一定的保护作用。