文章摘要
贾川,谢子康,彭立波,高益,赵洪,瞿玉兴.磷酸肌酸钠预注射对全膝关节置换术病人骨骼肌缺血再灌注损伤的影响.骨科,2019,10(1):19-24
磷酸肌酸钠预注射对全膝关节置换术病人骨骼肌缺血再灌注损伤的影响
Effects of pre-injection of sodium creatine phosphate on skeletal muscle ischemia-reperfusion injury after total knee arthroplasty
投稿时间:2018-04-06  
DOI:10.3969/j.issn.1674-8573.2019.01.004
中文关键词: 磷酸肌酸钠  缺血再灌注损伤  止血带反应  关节成形术,置换  膝关节
英文关键词: Sodium creatine phosphate  Ischemia-reperfusion injury  Tourniquet response  Arthroplasty, replacement  Knee
基金项目:江苏省自然科学基金(BK20131485);常州市科技计划(CJ20141205)
作者单位E-mail
贾川 南京中医药大学南京 210046  
谢子康 南京中医药大学附属常州市中医医院骨一科江苏常州 213000  
彭立波 南京中医药大学附属常州市中医医院骨一科江苏常州 213000  
高益 南京中医药大学附属常州市中医医院骨一科江苏常州 213000  
赵洪 南京中医药大学附属常州市中医医院骨一科江苏常州 213000  
瞿玉兴 南京中医药大学附属常州市中医医院骨一科江苏常州 213000 qyx8848@163.com 
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中文摘要:
      目的 探讨磷酸肌酸钠预注射对全膝关节置换术(total knee arthroplasty, TKA)病人骨骼肌缺血再灌注损伤(ischemia reperfusion injury, IRI)的影响。方法 选取2016年6月至2017年6月于常州市中医医院择期行初次单侧TKA的病人70例,随机分为磷酸肌酸钠组和对照组,各35例。磷酸肌酸钠组在上止血带前30 min静脉滴注磷酸肌酸钠 30 mg/kg(溶于100 ml生理盐水),输注时间为30 min。对照组注射等量的生理盐水。记录并比较两组病人手术开始时、松止血带即刻、松止血带后30 min、松止血带后1 h这4个时间点的血清白细胞介素1β(IL-1β)、白细胞介素6(IL-6)、白细胞介素8(IL-8)、丙二醛(MDA)、肿瘤坏死因子α(TNF-α)、乳酸脱氢酶(LDH)、超氧化物歧化酶(SOD)水平;记录病人术后1、3、7 d时患肢根部的疼痛视觉模拟量表(visual analogue scale, VAS)评分。结果 与手术开始时的各指标数值相比,松止血带即刻、松止血带后30 min、松止血带后1 h时两组的IL-1β、IL-6、IL-8、MDA、TNF-α、LDH水平均显著升高,而SOD水平显著降低;而且,除松止血带后的IL-8水平,磷酸肌酸钠组各观察时间点IL-1β、IL-6、IL-8、MDA、TNF-α、LDH的数值均显著低于对照组,而SOD水平显著高于对照组;术后磷酸肌酸钠组患肢根部的VAS评分明显小于对照组。上述指标比较,差异均有统计学意义(P均<0.05)。结论 磷酸肌酸钠预注射可预防TKA术后病人骨骼肌IRI,可用于改善术后止血带反应。
英文摘要:
      Objective To investigate the effect of pre-injection of sodium creatine phosphate on skeletal muscle ischemia-reperfusion injury (IRI) after total knee arthroplasty (TKA). Methods From June 2016 to June 2017, 70 patients with primary unilateral TKA were selected from Changzhou Traditional Chinese Medicine Hospital. They were randomly divided into experimental group and control group. In the experimental group, intravenous sodium creatine phosphate 30 mg/kg (dissolved in 100 ml physiological saline) was infused 30 min before the upper tourniquet, and the infusion time was 30 min. The control group was injected with an equal amount of physiological saline. The serum interleukin-1β (IL-1β), IL-6, and IL-8, malondialdehyde (MDA), serum tumor necrosis factor (TNF)-α, lactate dehydrogenase (LDH), superoxide dismutase (SOD) at the beginning of surgery, and immediate, 30 min and 1 h after loosing tourniquet were determined and compared between two groups. The visual analogue scale (VAS) scores were recorded at 1st, 3rd and 7th day after operation. Results Compared with the beginning of the operation, the level of IL-1β, IL-6, IL-8, MDA, TNF-α, LDH was significantly increased, and the SOD was significantly decreased immediate, 30 min, and 1 h after loosing tourniquet. Compared with the control group, except for the level of IL-8 after loosing tourniquet, IL-1β, IL-6, IL-8, MPA, TNF-α and LDH levels in experimental group at all time points decreased significantly, while SOD increased significantly (P<0.05 for all). The VAS score of the root in the experimental group was significantly lower than that in the control group (P<0.05). Conclusion Sodium creatine phosphate pre-injection has protective effect on skeletal muscle IRI after TKA and can be used to prevent postoperative tourniquet response.
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