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上海市卫生健康委员会
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全膝关节置换术中气压式止血带使用与否对血一氧化氮和内皮素的影响
The effect of using pneumatic tourniquet or not on the level of blood nitricoxide and endothelin during the total knee arthroplasty

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DOI:
作者:
楼尉,陈骏萍,张玉楚
Lou wei,Cheng junping,Zhang yuchu.
作者单位:
宁波市第二医院麻醉科
Department of Anesthesiology ，Ningbo NO2.hospital
关键词:
气压式止血带；全膝关节置换术；骨关节炎， 一氧化氮, 内皮素
pneumatic tourniquet； total knee arthroplasty；osteoarthritis，nitric oxide, endothelin
摘要:
目的 通过比较全膝关节置换术期间，使用气压式止血带与否对患肢静脉血NO和ET的影响。 方法 使用气压式止血带20例（Ⅰ组），不使用气压式止血带20 例（Ⅱ组）。分别于止血带使用前（T1），开放后即刻（T2），开放后一小时（T3），术后第一天（T4）采集患肢股静脉血标本测定NO和ET。 结果 使用气压式止血带组，在气压式止血带放开即刻（T2）血浆中NO浓度为61.76±3.39μml/L，较基础NO浓度明显下降（P＜0.01）；和Ⅱ组对应时间点（T2）NO浓度相比有显著差异（P＜0.01）。Ⅰ组ET浓度变化无统计学差异，但气压式止血带放开即刻（T2）NO/ET数值较基础值明显降低（P＜0.05）。Ⅱ组（对照组）各时间点ET、NO、NO/ET与组内基础值比较均无明显差异。 结论 全膝关节术中使用气压式止血带，患肢NO明显降低，可能会引起了患肢缺血-再灌注损伤；对于合并有高血压和（或）血管疾病的老年人全膝关节手术，应充分地考虑到止血带的潜在并发症。
Objective To investigate the influences of pneumatic tourniquet on the nitricoxide and endothelin levels within the wounded limb venous of patients undergoing the total knee arthroplasty. Method Forty patients were scheduled to undergoing the total knee arthroplasty surgery, while, 20 patients (GroupⅠ) were allocated in the pneumatic tourniquet group, and 20 patients (groupⅡ) were allocated in the control group without the pneumatic tourniquet treatment. Blood from the femoral vein of the wounded limps of these patients were sampled at different time-points as before pneumatic tourniquet aerating (baseline, T1), immediately after pneumatic tourniquet releasing (T2), 1 hour after pneumatic tourniquet releasing (T3) and 24h after operation (T4), respectively, to measure the values of nitricoxide (NO) and Endothelin (ET). Results In the Pneumatic tourniquet group, the NO concentration immediately after pneumatic tourniquet releasing (T2) was 61.76 ± 3.39μml / L, and decreased significantly when compared with the values of baseline (P <0.01), and the same time-point values of the control group (P <0.01), the NO/ET value of the T2 were still decreased when compared with baseline value (P＜0.05). The ET values had not any significant differences among these time-points of patients in both groups. Conclusions Using pneumatic tourniquet during the total knee arthroplasty can reduce the NO level of the patients’ wounded limb venous, and might produce the ischemia-reperfusion injury. These potential complications related to the pneumatic tourniquet should be taken into account when the aged patients with hypertension and (or) vascular disease undergoing the total knee arthroplasty.

 

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