| 陈慧霞,陈永学,王新波,等.维生素C联合依托咪酯对膝关节置换术后氧化应激及炎症因子水平的影响.骨科,2022,13(6): 522-526. |
| 维生素C联合依托咪酯对膝关节置换术后氧化应激及炎症因子水平的影响 |
| Effects of Vitamin C Combined with Etomidate on the Lower Extremity Ischemia-reperfusion Injury after Knee Replacement |
| 投稿时间：2022-07-26 |
| DOI：10.3969/j.issn.1674-8573.2022.06.009 |
| 中文关键词: 维生素C注射液 依托咪酯 关节成形术，置换，膝 氧化应激 炎症因子 |
| 英文关键词: Vitamin C injection Etomidate Arthroplasty, replacement, knee Oxidative stress Inflammatory cytokines |
| 基金项目:河北省2020年度医学科学研究课题计划（20200484） |
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| 中文摘要: |
| 目的 探讨维生素C注射液联合依托咪酯对膝关节置换术后病人氧化应激及炎症因子水平的影响。方法 纳入于我院行择期膝关节置换术的70例病人，按随机数字表法分为观察组和对照组。对照组给予丙泊酚辅助诱导麻醉及麻醉维持，观察组给予依托咪酯辅助麻醉诱导及麻醉维持，并在麻醉诱导前10 min、术中麻醉维持时、手术结束时及术后12 h分别予维生素C注射液0.5 g。于术前（T0）、术毕麻醉停止前（T1）、术后1 d（T2）、术后3 d（T3）、术后5 d（T4）这5个时间点分别抽取病人的外周静脉血，检测超氧化物歧化酶（SOD）、丙二醛（MDA）、肿瘤坏死因子-α（TNF-α）和白介素-6（IL-6）的水平。采用疼痛视觉模拟量表（VAS）对所有病人术后1、3、5 d的疼痛程度进行评分。结果 观察组中有1例退出研究，最终观察组纳入34例，对照组纳入35例。两组病人的年龄、性别、身体质量指数（BMI）、美国麻醉医师协会（ASA）分级、手术时间及止血带使用时间比较，差异均无统计学意义（P均＞0.05）。两组病人T0和T1时间点的SOD和MDA水平比较，差异无统计学意义（P＞0.05）；在T2、T3、T4时间点，观察组的SOD水平显著高于对照组，而MDA水平显著低于对照组（P＜0.05）；从T0到T4，SOD水平变化趋势为先降低，然后在T4点升高，MDA水平变化趋势为先升高，然后在T4点降低。两组病人T0时的TNF-α和IL-6水平比较，差异无统计学意义（P＞0.05）；在T1、T2、T3、T4时间点，观察组的TNF-α和IL-6水平显著低于对照组（P＜0.05）；从T0到T4，TNF-α和IL-6水平变化趋势为先升高，然后在T3点逐渐降低。观察组术后1、3 d的VAS评分显著低于对照组（P＜0.05）。结论 维生素C注射液联合依托咪酯可有效降低膝关节置换术病人的氧化应激水平和炎症反应，减小缺血再灌注损伤的影响，降低术后疼痛程度。 |
| 英文摘要: |
| Objective To investigate the effects of vitamin C injection combined with etomidate on the levels of oxidative stress and inflammatory factors in patients with lower extremity ischemia-reperfusion injury after knee replacement. Methods A total of 70 patients who underwent elective knee replacement in our hospital were included, and all patients were randomly assigned to observation group and control group according to the random number table method. The control group was given propofol assisted induction and maintenance of anesthesia, while the observation group was given etomidate. Vitamin C injection 0.5 g was given in observation group at 10 min before induction, during maintenance of anesthesia during operation, at the end of surgery, and 12 h after surgery. Peripheral venous blood was extracted from patients preoperation (T0), postoperative anesthesia (T1), postoperative day 1 (T2), postoperative day 3 (T3), postoperative day 5 (T4), respectively, and the levels of superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected. The visual analogue scale (VAS) was used to evaluate the pain degree of all patients at 1, 3 and 5 days after operation. Results One case in the observation group withdrew from the study. Totally, 34 cases in the final observation group and 35 cases in the control group were included. There was no significant difference in age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, operation time and tourniquet use time between the two groups (P＞0.05). There were no significant differences in SOD and MDA levels between two groups at T0 and T1 (P＞0.05). At T2, T3 and T4, SOD level in observation group was significantly higher than that in control group, while MDA level was significantly lower than that in control group (P＜0.05). The change trend of SOD level from T0 to T4 was first decreased, and then increase at T4. From T0 to T4, MDA level tended to increase at first and then decreased at T4. There was no significant difference in the levels of TNF-α and IL-6 at T0 between two groups (P＞0.05). At T1, T2, T3 and T4, the levels of TNF-α and IL-6 in the observation group were significantly lower than those in the control group (P＜0.05). From T0 to T4, the levels of TNF-α and IL-6 tended to increase first and then decrease gradually at T3. The VAS score of the observation group was significantly lower than that of the control group at 1 and 3 days after operation (P＜0.05). Conclusion Vitamin C injection combined with etomidate can effectively reduce the level of oxidative stress and inflammatory response in patients with lower limb ischemia-reperfusion injury after knee replacement, lower the effects of ischemia-reperfusion injury, and decrease the degree of postoperative pain. |
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