【摘要】 目的探讨依达拉奉对止血带性肺损伤的影响及作用机制。方法 44例ASAⅠ～Ⅱ级、单侧下肢手术需用止血带、手术时间1～1.5h患者,年龄25～60岁,随机分为3组:上止血带前注射依达拉奉组(E1组,n=14),上止血带后注射依达拉奉组(E2组,n=15),对照组(C组,n=15)。均采用L2～3的连续硬膜外麻醉。在上止血带前(T0)、上止血带后60min(T1)、松止血带后30min(T2)、2h(T3)、6h(T4)、24h(T5)各时点抽取桡动脉血行血气分析,并测定IL-6、IL-8、MDA、SOD的浓度及MPO的活性。结果与T0时比较,C组T4时动脉血氧分压降低,肺泡-动脉血氧分压差和呼吸指数升高,在T3～5时IL-6和IL-8浓度升高(P<0.05);在T2～5时MDA浓度升高,SOD降低(P<0.05);在T2～4时MPO升高(P<0.05)。E1组和E2组在T3,4时与T0比较IL-6和IL-8浓度升高(P<0.05),但与同时点的C组相比浓度明显减少(P<0.05);在T2～5时与T0比较MDA和SOD无明显差异(P>0.05),与同时点的C组比较明显减少(P<0.05);在T2～4时与T0比较MPO无明显差异(P>0.05),与同时点的C组比较明显减少(P<0.05)。结论依达拉奉可有效改善下肢手术患者松止血带后肺功能,其机制与清除氧自由基、抑制脂质过氧化反应,抑制炎性细胞因子过度释放及减少中性粒细胞的聚集有关。更多还原

【Abstract】 Objective To investigate the protective effect of edaravone on lung injury induced by tourniquets in patients undergoing orthopedic operations.Methods Forty-four patients aged 25-60 years,whose tourniquets duration varied from 1 to 1.5h and matched American Society of Anesthesiologists Physical Status Ⅰ-Ⅱ,were randomly divided into three groups.Edaravone 0.5mg/kg was given intreavenous before tourniquet inflation(group E1,n=14) or after tourniquet inflation(group E2,n=15).Equal volume of normal saline was infused at the same time points in control group(group C,n=15).Patients in three group received epidural block(L2-3) for operation.Radial arterial blood gas analysis for measuring the concentration of interleukin-6(IL-6),interleukin-8(IL-8),malondialdehyde(MDA),superoxide dismutase(SOD) and activity of myeloperoxidase(MPO) were taken just before tourniquet inflation(T0),1h after inflation(T1),and 0.5h(T2),2h(T3),6h(T4),24h(T5) after tourniquet deflation.Results Compared with T0 point,PaO2,A-aDO2 and RI in T4 point were increased,the concentration of IL-6 and IL-8 in T3-5 points were also increased,the concentration of MDA was increased but the concentration of SOD was decreased in T2-5 points,the activity of MPO were also increased in T2-5 points in group C(P<0.05).The concentration of IL-6 and IL-8 in T3,4 points was significantly higher in group E1 and E2 than that in T0 point and was significantly less than that in group C(P<0.05).There was no significantly difference in concentration of MDA,SOD and the activity of MPO in T0-5 points in group E1 and E2(P>0.05),but was significantly less than that in group C(P<0.05).Conclusion Edaravone being used in patients with lower limb surgery can improve lung function after tourniquet release which might be attributed to scavenging oxygen free radicals,inhibiting lipid peroxidation,inhibiting the excessive release of inflammatory cytokines and reducing neutrophil accumulation.更多还原