喷他佐辛对止血带致下肢缺血/再灌注后心肌肌钙蛋白Ⅰ的影响

目的 观察喷他佐辛对下肢缺血/再灌注(ischemia/reperfusion,I/R)后心肌肌钙蛋白Ⅰ(cardiac troponin Ⅰ,cTnⅠ)的影响及其与降钙紊基因相关肽(calcitonin gene-related peptide,CGRP)的关系. 方法 选取择期在蛛网膜下腔麻醉下行单侧下肢骨科手术使用止血带患者60例,按照随机数字表法分为对照组(C组)和喷他佐辛组(P组),每组30例.止血带充气前P组患者给予喷他佐辛0.5 mg/kg静脉滴注,C组在相同时刻给予等量生理盐水.在止血带充压前(To)及止血带释压后0.5 h(T0、24 h(T2)时采集输液对侧肘静脉血5 nl,采用ELISA法检测血清中cTnⅠ和CGRP的含量. 结果 两组患者一般资料比较,差异无统计学意义(P＞0.05).与To时cTnⅠ[(0.2 1±0.06)μg/L]比较,C组cTnⅠ在T1时无明显变化(P＞0.05),在T2[(0.28±0.10) μg/L]时明显升高(P＜0.05),P组cTnⅠ在T1、T2时无明显变化(P＞0.05);与To时CGRP[(16.9±2.2) ng/L]比较,C组CGRP在T1、T2时均无明显变化(P＞0.05),P组CGRP在T1[(17.9±2.7) ng/L]、T2[(18.8±2.8) ng/L]时均明显升高(P＜0.05).与C组在T1、T2时cTnⅠ[(0.23±0.12)、(0.28±0.10) μg/L] 、CGRP[(16.9±1.9)、(16.7±2.6) ng/L]比较,P组的cTnⅠ在T1时无明显变化(P＞0.05),T2[(0.22±0.06) μg/L]时明显降低(P＜0.05),P组的CGRP在T1、T2时均明显升高(P＜0.05). 结论 喷他佐辛可以减轻下肢使用止血带诱发I/R后的cTnⅠ升高,可能与内源保护性神经肽CGRP有关.     

Understanding of intra-operative tourniquets amongst orthopaedic surgeons and theatre staff �C a questionnaire study

INTRODUCTION

Pneumatic tourniquets are used frequently in orthopaedic theatres to provide a bloodless field whilst operating on the extremities. Their use has given rise to complications and preventable damage due to over-pressurisation and prolonged application. We designed a questionnaire to assess the knowledge on tourniquet use among operating department assistants (ODAs) and specialist registrars (SpRs) in orthopaedic surgery.

SUBJECTS AND METHODS

A questionnaire was constructed using set guidelines from the Association of periOperative Registered Nurses (AORN) for recommended practice of tourniquet application. This was distributed to orthopaedic registrars with varying levels of experience and ODAs from five different NHS hospitals. The unpaired, two tailed t-test was used to test for statistical significance of results.

RESULTS

A total of 54 completed questionnaires were collected for analysis. The study population included 29 orthopaedic SpRs and 25 ODAs. The mean score for the orthopaedic SpRs as a group was 41.3% (SD 6.85; range, 29.0–54.8%). The mean score for the ODAs was 46.7% (SD 9.64; range, 23.3–62.9%) with a P-value of 0.024.

CONCLUSIONS

Most surgeons are taught how to use pneumatic tourniquets by their senior colleagues as no formal teaching is given. Most of the complications are infrequent and preventable. However, their consequences can be devastating to the patient with medicolegal implications. Our results show suboptimal knowledge of tourniquets and their use among SpRs and ODAs. This study highlights the need for amendments in training to improve the knowledge and awareness of medical practitioners on the application and use of tourniquets to prevent adverse events and improve patient safety.     

止血带与全膝关节置换术肺脂肪栓塞风险的实验研究

目的探讨止血带对全膝关节置换术（TKA）肺脂肪栓塞产生的影响。方法16只杂种犬随机分为两组。实验组：模拟TKA截骨、扩髓,插入髓内杆,术中使用止血带;对照组：术中操作同实验组,术中不使用止血带。术中监测不同时间动脉血气分析、凝血指标和血管内皮损伤指标,术后进行肺脏病理检查并采用病理学评分计算肺损伤程度。结果血气分析监测发现在释放止血带后5min内实验组氧分压下降值高于对照组（P〈0．05）。凝血酶原时间和活化部分凝血活酶时间两组问的差异无统计学意义。术后实验组组织型纤溶酶原激活物低于对照组（P〈0．05）,血管性血友病因子和血栓调节蛋白均高于对照组（P〈0．05）。肺损伤总分实验组高于对照组（5．6±2．3）υs（3．2±1．4）,（P〈0．05）。结论TKA术中使用止血带可能损伤血管内皮,止血带释放时可能干扰呼吸系统功能,增加肺脏脂肪栓塞的发生风险。