喷他佐辛对止血带致下肢缺血再灌注后血清炎症因子的影响

摘要

目的：观察喷他佐辛对止血带致下肢缺血再灌注后血清中肿瘤坏死因子-α（ TNF-α）、白介素6（ IL-6）、白介素10（IL-10）的影响。方法：选取择期行单侧下肢骨科手术使用止血带患者40例，随机分为对照组（C组，n越20）和喷他佐辛治疗组（P组，n越20）。麻醉后P组患者给予喷他佐辛（0.5 mg/kg溶入100 mL生理盐水，30 min静脉滴注完毕），C组在相同时间点给予等量生理盐水。所有手术均采用蛛网膜下隙麻醉。记录患者一般情况以及上止血带前（T0），松止血带前（T1），松止血带1 min（T2），松止血带30 min（T3），术后24 h（T4）的心率、血氧饱和度、平均动脉压。分别在T0，T3，T4时刻采取外周静脉血5 mL，应用酶联免疫吸附测定法（ELISA）检测血清TNF-α，IL-6，IL-10的水平。结果：两组一般情况和术中血流动力学比较，差异无统计学意义（ P跃0.05）。两组相比三个时点的TNF-α均未见明显变化（P跃0.05）。与C组比较，P组IL-6在T3，T4时点均明显降低（P约0.05）；IL-10在T3时，明显升高（P约0.05）；T4时点两组比较，差异无统计学意义（P跃0.05）。结论：喷他佐辛可有效抑制下肢缺血再灌注后IL-6的生成，促进IL-10的生成，可能有利于患者的术后恢复。%Objective:Theaimofthisstudywastoexploretheeffectofpentazocineonthechangesofseruminflammatory factors tumor necrosis Factor-alpha( TNF-α),interleukin-6( IL-6 ),interleukin-10( IL-10 )in lower limbischemia reperfusion injury induced by tourniquet. Methods:Forty patients,undergoing elective unilateral leg surgery using tourniquet, were enrolled and randomly assigned to control group(group C,n=20)and pentazocine treatment group(group P,n=20). Pa-tients in group P pretreated with pentazocine(0. 5 mg/kg,in 100 mL of 0. 9% saline,intravenously infused in 30 min)after anesthesia,while only the same volume of saline was infused intravenously in group C at the same schedule. The operations were carried out under spinal anesthesia. Record the heart rate,thesaturation of pulse oxygenand mean arterial pressureat the time of before inflating tourniquet(T0),before deflating tourniquet(T1),1 minute(T2),30 minutes(T3)and 24 hours(T4) after tourniquet deflation. Peripheral venous blood samples were collected at the time of T0,T3 and T4. Serum concentration of TNF-α,IL-6 and IL-10 were measured by using enzyme-linked immunosorbent assay( ELISA). Results:There were no statistical difference detected in the general status and thehemodynamic changes between the group C and P(P>0. 05). The concentration of TNF-αhave no variation in two group at the three moments(P>0. 05). Compared with group C,the level of IL-6 in group P were significantly decreased at the time of T3 and T4(P<0. 05),the level of IL-10 in group P was in-creased at the time of T3(P<0. 05),while there was no stastistical difference of IL-10 in two group at the time of T4(P>0. 05). Conclusion:These results indicated that pentazocine could suppress the inflammatory reactions in lower limbischemia reperfusion injury induced by tourniquet,which may beneficial for patient recovery.