止血带应用对下肢手术患者心、肝、肾功能的影响

目的观察止血带所致的缺血再灌注对下肢手术患者心、肝、肾功能的影响。方法选择美国麻醉医师协会评分Ⅰ～Ⅱ级,年龄25～60岁,止血带充气1.0～1.5h,择期单侧下肢手术病人20例,分别于扎止血带前、扎止血带后1 h、止血带松开后0.5、2、6和24h记录血压、心率,并测定血清戊二醛、白介素-6、白介素-8、一氧化氮、内皮素-1、缺血修饰白蛋白、谷氨酸丙酮酸转氨酶、谷氨酸草酰乙酸转氨酶、胱抑素C和β2-微球蛋白浓度。结果与基础值比较,止血带松开后2～24h患者血清戊二醛、白介素-6、白介素-8、内皮素-1浓度升高,而一氧化氮浓度与一氧化氮/内皮素-1比值下降(P<0.01),各时点血压、心率、血清缺血修饰白蛋白、谷氨酸丙酮酸转氨酶、谷氨酸草酰乙酸转氨酶、胱抑素C和β2-微球蛋白浓度改变均无统计学意义(P>0.05)。结论止血带应用可导致脂质过氧化、全身炎症反应及一氧化氮/内皮素-1失衡,但不影响择期下肢手术患者心、肝、肾功能。

Effects of Tourniquet Application on Cardiac, Hepatic and Renal Function in Patients Undergoing Lower Extremity Surgery

Objective To investigate the effect of tourniquet-induced ischemia reperfusion on cardiac,hepatic and renal function in patients undergoing lower extremity surgery.Methods Twenty patients with American Society of Anesthesiology(ASA) physical status Ⅰ-Ⅱ,aging 25-60year,tourniquet duration 1.0-1.5h,who scheduled for lower extremity surgery were studied.Serum levels of malondialdehyde(MDA),interleukin-6,8(IL-6,8),nitric oxide(NO),endothelin-1(ET-1),ischemia modified albumin(IMA),glutamate pyruvate transaminase(GPT),glutamate oxaloacetic transaminase(GOT),cystatin C and β2-microglobulin were measured just before tourniquet inflation,1h after inflation and 0.5,2,6 and 24h after tourniquet deflation.Results In comparison with the baseline values,serum levels of MDA,IL-6,IL-8,ET-1 from 2h to 24h after tourniquet deflation were significantly increased(P<0.01),while serum NO levels and NO/ET-1 ratios were decreased.However,no significant changes in blood pressure,heart rate,IMA,GPT,GOT,cystatin C and β2-microglobulin levels were revealed(P>0.05).Conclusion Lower limb ischemia-reperfusion associated with the clinical use of a tourniquet could lead to lipid peroxidation,systemic inflammatory response and NO/ET-1 imbalance,while with little effects on cardiac,hepatic and renal function.