人工全膝关节置换围术期红细胞脂质过氧化与维生素E、1,6-二磷酸果糖的关系

背景:近年研究表明.手术创伤等可使红细胞脂质过氧化损伤,而损伤变形的红细胞对置换后血栓形成起非常重要的作用.目的:观察人工伞膝芙节置换对红细胞脂质过氧化的影响及维生素E、1,6-二磷酸果糖对围手术期红细胞脂质过氧化的干预效应.设计、时间及地点:对比观察临床试验,2003-01/2006-06在南通人学附属医院骨科进行.对象:膝关节退变伴骨性关节炎患者60例,于硬膜外阻滞麻醉下行人工全膝关节置换,分为4组:即对照组、维生素E组、1,6-二磷酸果糖组及维生素E 1,6-二磷酸果糖组(联合组),每组15例.方法:维牛素E组在置换前3 d开始口服维生素E,3次,d,每次100mg,甭手术日晨;1,6-二磷酸果糖组于手术开始后30 min给1,6-二磷酸果糖10g静脉滴注;维生素E 1,6-二磷酸果糖组在置换前3 d开始口服维生素E,3次,d,每次100 mg,至手术日晨,同时于手术开始后30 min给1,6-二磷酸果糖10g静脉滴注.在置换前,置换后1,3,5,7d抽取血样.主要观察指标:测定红细胞中丙二醛和铜-锌-超氧化物歧化酶的含量.结果:置换后第5天和第7天,维生素E组和1,6-二磷酸果糖组丙二醛的浓度高于联合组及置换前(P<0.05),铜-锌-超氧化物歧化酶的含量低于联合组及置换前(P<0.05),而联合组与置换前相比差异无显著性P>0.05).结论:人工全膝关节置换可引起患者机体红细胞脂质过氧化增强和抗氧化能力下降,置换前和置换过程中联合应用维生素E和1.6-二磷酸果糖能在置换后较长时间内预防患者机体红细胞脂质过氧化和抗氧化能力下降.

Effect of vitamin E and fructose 1,6-diphosphate on lipid peroxidation in erythrocytes during artificial total knee replacement

BACKGROUND:Recent studies have demonstrated that surgical trauma leads to lipid peroxidation in erythrocytes.However,injured erythrocytes play an important role in thrombosis following replacement.OBJECTIVE:To evaluate the influence of artificial total knee replacement on the lipid peroxdation in erythrocytes,and the prophylactic treatment of vitamin E and fructose 1,6 diphosphate(FDP)on it.DESIGN,TIME AND SETTING:Contrast clinical study,which was carried out in the Department of Otthopaedics,Affiliated Hospital of Nantong University from January 2003 to June 2006.PARTICIPANTS:Sixty patients with knee osteoarthritis who underwent artificial total knee replacement by anesthesia of epidural block were divided into four groups,including control group,vitamin E group,FDP group and vitamin E+FDP group,with 15 cases in each group.METHODS:Vitamin E was orally taken in the vitamin E group three days before replacement,three times a day,100 mg for each.The administration was performed until the surgical morning.Thirty minutes after the operation,FDP(10 g)was intravenously dripped in the FDP group.Additionally.vitamin E was also orally taken in the vitamin E+FDP group three days before replacement,three times a day,100 mg for each;on the surgical morning,FDP(10 g)was intravenously dripped on the first 30minutes.Blood samples were taken for biochemical determination before and after the operation at 1,3,5,and 7 days.MAIN OUTCOME M[EASURES:Corltents of malonaldehyde(MDA)and cuprum/zincum/superoxide dismutase (Cu-Zn-SOD)in the erythrocytes.RESULTS:MDA level in the vitamin E group and FDP group was significantly higher than that in the vitamin E+FDP group before and 5 and 7 days after replacement(P<0.05);while,Cu-Zn-SOD level was significantly lower(P<0.05).Otherwise,there were no significant differences in vitamin E+FDP group before and after replacement(P>0.05).CONCLUSION:The artificial total knee replacement can enhance lipid peroxidation and decrease antioxygen capability.However,the combination of vitamin E and FDP can prevent and relieve lipid peroxidation and antioxygen capability after replacement.