天津医药

天津医药 ›› 2022, Vol. 50 ›› Issue (8): 849-852.doi: 10.11958/20212741

• 临床研究 • 上一篇    下一篇

布托啡诺不同给药时机对骨科止血带所致缺血再灌注损伤的氧化应激和炎症反应的影响

彭雅琪1(), 王丹1, 赵丽霞1, 原大江1,2,Δ()   

  1. 1山西医科大学麻醉学院（邮编030001）
    2山西医科大学第二医院重症医学科
  • 收稿日期:2021-12-13 修回日期:2022-01-17 出版日期:2022-08-15 发布日期:2022-08-12
  • 通讯作者: 原大江 E-mail:pyq18834890556@163.com;yuandajiang@sina.com
  • 作者简介:彭雅琪（1994）,女,硕士在读,主要从事麻醉与器官功能调控与保护方面研究。E-mail： pyq18834890556@163.com
  • 基金资助:
    国家自然科学基金资助项目(81860516)

Effects of different administration timing of butorphanol on oxidative stress and inflammatory response of ischemia-reperfusion injury induced by orthopaedic tourniquet

PENG Yaqi1(), WANG Dan1, ZHAO Lixia1, YUAN Dajiang1,2,Δ()   

  1. 1 College of Anesthesiology, Shanxi Medical University, Taiyuan 030001, China
    2 Department of Critical Medicine, the Second Hospital of Shanxi Medical University
  • Received:2021-12-13 Revised:2022-01-17 Published:2022-08-15 Online:2022-08-12
  • Contact: YUAN Dajiang E-mail:pyq18834890556@163.com;yuandajiang@sina.com

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摘要：

目的 探讨布托啡诺不同给药时机对骨科止血带所致缺血再灌注损伤的氧化应激和炎症反应的影响。方法 将90例择期行下肢骨科手术患者随机分为布托啡诺预处理组（Y组）、布托啡诺后处理组（H组）和对照组（C组）,每组30例,均采取蛛网膜下腔阻滞。在止血带充气前5 min,Y组患者缓慢静脉注射0.02 mg/kg布托啡诺;在止血带放气前5 min,H组患者缓慢静脉注射0.02 mg/kg布托啡诺;C组患者不予特殊处理。比较负荷药物前（T0）,止血带充气后30 min（T1）、60 min（T2）,止血带放气后5 min（T3）的平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）,测定T0、T3时血清肿瘤坏死因子-α（TNF-α）、丙二醛（MDA）、超氧化物歧化酶（SOD）。结果 3组间各时间点HR、MAP、SpO2差异均无统计学意义,3组内各时间点HR和SpO2差异无统计学意义;与T0相比,H组和C组T2时MAP显著升高,T3时MAP显著降低,Y组T3时MAP显著降低（P<0.05）。与T0时比较,3组患者T3时血清MDA、TNF-α水平上升,血清SOD水平下降（P<0.05）。T3时Y组、H组血清MDA、TNF-α水平较C组降低,血清SOD水平升高（P<0.05）,但Y组和H组患者之间差异无统计学意义。结论 布托啡诺预处理和后处理均可有效减少使用止血带所致的缺血再灌注损伤,这可能与抑制氧化应激和炎症反应有关。

关键词: 布托啡诺, 再灌注损伤, 下肢, 氧化性应激, 预处理, 后处理, 炎症反应

Abstract:

Objective To investigate the effects of different administration timing of butorphanol on oxidative stress and inflammatory response of ischemia-reperfusion injury induced by orthopaedic tourniquet. Methods Ninety patients undergoing elective orthopedic lower limb surgery were randomly divided into the butorphanol pretreatment group (group Y), the butorphanol post-treatment group (group H) and the control group (group C), with 30 patients in each group. Subarachnoid block were used in the three groups of patients. Patients in group Y received a slow bolus of 0.02 mg/kg butorphanol intravenously 5 min before tourniquet inflation. A slow bolus of 0.02 mg/kg butorphanol was administered intravenously to patients in group H 5 min before the tourniquet was deflation. Patients in group C were not specifically addressed. Mean arterial pressure (MAP), heart rate (HR), saturation of pulse oximetry (SpO2) values were compared before loading medication (T0), 30 min after tourniquet inflation (T1), 60 min after tourniquet inflation (T2), and 5 min after tourniquet deflation (T3). Serum tumor necrosis factor -α (TNF-α), malondialdehyde (MDA) and superoxide dismutase (SOD) were measured at T0 and T3. Results There were no significant differences in HR, MAP and SpO2 at each time point between the three groups. There were no significant differences in HR and SpO2 at each time point between groups. Compared with T0, MAP was significantly increased at T2 in the group H and the group C, decreased significantly at T3 in group Y (P<0.05). Compared with T0, serum levels of MDA and TNF-α increased at T3 in the three groups of patients, and the serum level of SOD decreased (P<0.05). At T3, serum levels of MDA and TNF-α were significantly lower in the group Y and the group H than those in the group C, and the serum level of SOD was significantly higher than that in the group C (P<0.05). However, there were no significant differences in the serum concentrations of MDA, SOD and TNF-α between the group Y and the group H. Conclusion Butorphanol pretreatment and post-treatment can effectively reduce the ischemia-reperfusion injury caused by tourniquet, which may be related to the inhibition of oxidative stress and inflammatory response.

Key words: butorphanol, reperfusion injury, lower extremity, oxidative stress, pretreatment, post treatment, inflammatory reaction

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