下肢缺血预处理和乌司他丁静注对老年患者单膝关节置换术后心肺功能变化的影响

卢孙山; 陈星同; 何心海; 田国平; 吕锐; 曹剑; 易斌; 甯交琳; 鲁开智; 顾健腾

doi:10.16016/j.1000-5404.201906236

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下肢缺血预处理和乌司他丁静注对老年患者单膝关节置换术后心肺功能变化的影响

临床医学 | 更新时间：2026-01-09

- 下肢缺血预处理和乌司他丁静注对老年患者单膝关节置换术后心肺功能变化的影响
- Effect of ischemic preconditioning and ulinastatin infusion on cardiopulmonary function in the elderly after single knee replacement
- 第三军医大学学报 2019年41卷第21期页码：2094-2100
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
- 作者简介：
  
  [顾健腾，E-mail: gjt1976@163.comGU Jianteng, E-mail: gjt1976@163.com
- 基金信息：
  
  陆军军医大学第一附属医院临床科研基金(SWH2016LCYB-18)
- DOI：10.16016/j.1000-5404.201906236
  中图分类号： R339.34;R364.12;R687.4
- 收稿：2019-06-27，
  
  修回：2019-08-01，
  
  纸质出版：2019-11-15
- 稿件说明：
移动端阅览
卢孙山, 陈星同, 何心海, 等. 下肢缺血预处理和乌司他丁静注对老年患者单膝关节置换术后心肺功能变化的影响[J]. 第三军医大学学报, 2019,41(21):2094-2100.

Sunshan LU, Xingtong CHEN, Xinhai HE, et al. Effect of ischemic preconditioning and ulinastatin infusion on cardiopulmonary function in the elderly after single knee replacement[J]. Journal of Third Military Medical University, 2019, 41(21): 2094-2100.
卢孙山, 陈星同, 何心海, 等. 下肢缺血预处理和乌司他丁静注对老年患者单膝关节置换术后心肺功能变化的影响[J]. 第三军医大学学报, 2019,41(21):2094-2100. DOI： 10.16016/j.1000-5404.201906236.

Sunshan LU, Xingtong CHEN, Xinhai HE, et al. Effect of ischemic preconditioning and ulinastatin infusion on cardiopulmonary function in the elderly after single knee replacement[J]. Journal of Third Military Medical University, 2019, 41(21): 2094-2100. DOI： 10.16016/j.1000-5404.201906236.

摘要

目的

观察老年患者膝关节置换术后心肺功能的变化，并探索缺血预处理及乌司他丁静脉输注对其影响。

方法

选择2012年11月至2018年5月本院关节外科硬膜外联合蛛网膜下腔麻醉下单侧膝关节置换术老年患者45例，采用随机数字表法分为对照组(C组，

=15)、下肢缺血预处理组(IP组，

=15)和乌司他丁组(U组，

=15)。C组:常规麻醉管理；IP组:于术前对术肢止血带加压至480 mmHg，5 min后开放止血带，循环3次后开始手术；U组:于麻醉后20 min内静注乌司他丁20万单位，之后20单位/(kg·min)缓慢泵注直至手术结束。3组分别于术肢止血带松开前5 min(T

)、止血带松开后1 h(T

)、6 h(T

)、24 h(T

)抽取桡(股)动脉血，测定心肌酶谱(CK、CKMB、LDH)、血气分析(RI、cLac)、炎症细胞因子(TNF-α、IL-1、IL-6)、丙二醛(MDA)和黄嘌呤氧化酶(XOD)等。

结果

与T

相比，C组患者CK在T

、T

显著升高(

0.05)，RI在T

、T

显著增高(

0.05)，cLac、OXD在T

显著增高(

0.05)；与C组比较，IP组患者CK、RI、cLac、XOD在T

显著降低(

0.05)，U组显示出下调的趋势，但差异无统计学意义(

0.05)。各组CKMB、LDH、TNF-α、IL-1、IL-6及MDA组内及组间差异无统计学意义(

0.05)。

结论

膝关节置换术后老年患者心功能变化不大，肺功能可能不同程度受损，其原因在于氧化应激反应而不是系统性炎症反应；下肢缺血预处理可通过抑制氧化应激改善其肺功能。

Abstract

Objective

To observe the changes of cardiopulmonary function in elderly patients undergoing unilateral knee arthroplasty

and to explore the effects of ischemic preconditioning and ulinastatin infusion on them.

Methods

A total of 45 elderly patients undergoing knee arthroplasty under epidural combined subarachnoid anesthesia in our hospital from November 2012 to May 2018 were prospectively recruited in this study. They were randomly divided into control group (Group C

=15

routine anesthesia management)

limb ischemic preconditioning group (Group IP

=15

the tourniquet pressurized to 480 mmHg followed by being opened 5 min later

3 cycles before surgery) and ulinastati infusion group [Group U

=15

venous infusion of 200 kU ulinastatin within 20 min after anesthesia

then continuously pumping at 20 U/(kg·min) until the end of surgery

]

. Iliac (femoral) arterial blood samples were collected at 5 min before (T

) and 1 (T

)

6 (T

) and 24 h (T

) after tourniquets were relaxed. Myocardial enzymes detection (CK

CKMB

LDH)

blood gas analysis [respiratory index (RI)

lactic acid (cLac)

]

inflammatory cytokines (TNF-α

IL-1

IL-6)

malondialdehyde (MDA) and xanthine oxidase (XOD) measurement were carried out respectively.

Results

In Group C

CK were significantly increased at T

and T

(

0.05)

RI remarkably rose at T

and T

(

0.05)

cLac and OXD also elevated notably at T

(

0.05) when compared with the levels at T

. These markers were significantly reduced in Group IP at T

(

0.05) and tended to decline in Group U at the above time points (

0.05). There were no obvious differences in the levels of CKMB

LDH

TNF-α

IL-1

IL-6 and MDA in intra- or inter-groups (

0.05).

Conclusion

For the elderly patients undergoing knee arthroplasty

no significant changes are seen in cardiac function

but their pulmonary function may be impaired at different degrees due to oxidative stress instead of systemic inflammatory reaction. Lower limb ischemic preconditioning can improve pulmonary function by inhibiting oxidative stress.

关键词

Keywords

references

PRICE A J, ALVAND A, TROELSEN A, et al . Knee replacement[J ] . Lancet, 2018, 392(10158): 1672-1682. DOI:10.1016/s0140-6736(18)32344-4.

牛聪, 陈志勇, 朱美华, 等.参麦注射液对老年患者肢体缺血-再灌注后肺损伤的影响[J].临床麻醉学杂志, 2018, 34(7):651-654.DOI:10.12089/jca.2018.07.007.

NIU C, CHEN Z Y, ZHU M H, et al . Effect of Shenmai injection on pulmonary injury induced by lower extremity ischemia-reperfusion injury of senile patients[J ] .J Clin Anesthesiol, 2018, 34(7):651-654.DOI:10.12089/jca.2018.07.007.

王莉, 郝雪莲, 孙媛, 等.右美托咪定对老年糖尿病患者止血带性心肌损伤的影响[J].中国老年学杂志, 2017, 37(24):6134-6137.DOI:10.3969/j.issn.1005-9202.2017.24.056.

WANG L, HAO X L, SUN Y, et al . Effect of dexmedetomidine on tourniquet myocardial injury in elderly patients with diabetes[J ] . Chin J Gerontol, 2017, 37(24):6134-6137.DOI:10.3969/j.issn.1005-9202.2017.24.056.j.issn.1005-9202.2017.24.056.

朱诗白, 翟洁, 蒋超, 等.膝关节置换围手术期的快速康复措施[J].中国组织工程研究, 2017, 21(3):456-463.DOI:10.3969/j.issn.2095-4344.2017.03.024.

ZHU S B, ZHAI J, JIANG C, et al . Application of "enhanced recovery after surgery"in the perioperative period of total knee arthroplasty[J ] . J Clin Rehabil Tis Eng Res, 2017, 21(3):456-463.DOI:10.3969/j.issn.2095-4344.2017.03.024.

陈骞.不同时相远端缺血预处理对全膝关节置换术缺血再灌注损伤氧化应激和炎症因子的影响[J].现代中西医结合杂志, 2017, 26(20):2240-2243.DOI:10.3969/j.issn.1008-8849.2017.20.026.

CHEN Q. Effects of remote ischemic preconditioning at different time points on oxidative stress and inflammatory factors in ischemia-reperfusion injury of total knee arthroplasty[J]. Mod J Integr Tradit Chin West Med, 2017, 26(20):2240-2243.DOI:10.3969/j.issn.1008-8849.2017.20.026.

乔欣, 杜耘, 刘毅萍, 等.远端缺血预处理对全胸腔镜下心脏手术患者心肌的影响[J].临床麻醉学杂志, 2017, 33(11): 1074-1077.

QIAO X, DU Y, LIU Y P, et al .Effects of remote ischaemic preconditioning on cardiac function in heart operation under thoracoscope[J ] . J Clin Anesthesiol, 2017, 33(11): 1074-1077.

王增福, 房建军, 张宁.乌司他丁对大鼠肺缺血再灌注损伤的保护作用及对肺组织Clara细胞分泌蛋白的影响[J].临床和实验医学杂志, 2018, 17(7): 689-691.DOI:10.3969/j.issn.1671-4695.2018.07.005.

WANG Z F, FANG J J, ZHANG N. The protective effect of ulinastatin on lung ischemia-reperfusion injury in rats and its effect on secretory protein of Clara cells in lung tissue[J]. J Clin Exp Med, 2018, 17(7): 689-691.DOI:10.3969/j.issn.1671-4695.2018.07.005.

安鲁毅, 陈丽菲, 阮惠娟, 等.乌司他丁对高位脊髓损伤大鼠心肌组织及肺组织的保护作用[J].临床合理用药杂志, 2018, 11(22): 90-92. DOI:10.15887/j.cnki.13-1389/r.2018.22.050.

AN L Y, CHEN L F, RUAN H J, et al . Protective effect of ulinastatin on myocardial tissue and lung tissue in rats with high spinal cord injury[J ] . Chin J Clin Ration Drug Use, 2018, 11(22): 90-92. DOI:10.15887/j.cnki.13-1389/r.2018.22.050.

MANSOUR Z, CHARLES A L, KINDO M, et al . Remote effects of lower limb ischemia-reperfusion: impaired lung, unchanged liver, and stimulated kidney oxidative capacities[J ] . Biomed Res Int, 2014, 2014: 392390. DOI:10.1155/2014/392390.

任国强, 陈萍, 于金贵.右美托咪定对大鼠离体心脏缺血再灌注损伤心肌组织炎症反应和氧化应激损伤的影响[J].中国老年学杂志, 2018, 38(11): 2709-2712.

REN G Q, CHEN P, YU J G. Effects of dexmedetomidine on myocardial tissue inflammatory response and oxidative stress injury in isolated rat hearts with ischemia-reperfusion injury[J]. Chin J Gerontol, 2018, 38(11): 2709-2712.

高志强, 陈广卿, 王国庆, 等.大鼠运动性骨骼肌损伤后血清肌酸激酶、乳酸脱氢酶以及波形蛋白的变化[J].中国老年学杂志, 2016, 36(15):3634-3636.DOI:10.3969/j.issn.1005-9202.2016.15.010.

GAO Z Q, CHEN G Q, WANG G Q, et al . Changes of serum creatine kinase, lactate dehydrogenase and vimentin after exercise-induced skeletal muscle injury in rats[J ] . Chin J Gerontol, 2016, 36(15):3634-3636.DOI:10.3969/j.issn.1005- 9202.2016.15.010.

XIA F F, XIA Y, CHEN S S, et al . Lipid emulsion mitigates impaired pulmonary function induced by limb I/R in rats through attenuation of local cellular injury and the subsequent systemic inflammatory response/inflammation[J ] . BMC Anesthesiol, 2017, 17(1): 83. DOI:10.1186/s12871-017-0375-6.

唐帅, 徐仲煌, 杨宏, 等.乌司他丁对双侧全膝关节置换术后患者炎性反应和急慢性疼痛的影响[J].基础医学与临床, 2014, 34(4): 514-518. DOI:10.16352/j.issn.1001-6325.2014.04.023.

TANG S, XU Z H, YANG H, et al . The effect of ulinastatin on patients' inflammator y response, acute and chronic pain after bilateral total knee arthroplasty[J ] . Basic Clin Med, 2014, 34(4): 514-518. DOI:10.16352/j.issn.1001-6325.2014.04.023.

LIN L N, WANG L R, WANG W T, et al . Ischemic preconditioning attenuates pulmonary dysfunction after unilateral thigh tourniquet-induced ischemia-reperfusion[J ] . Anesth Analg, 2010, 111(2): 539-543. DOI:10.1213/ANE.0b013e3181e368d2.

KOCMAN E A, OZATIK O, SAHIN A, et al . Effects of ischemic preconditioning protocols on skeletal muscle ischemia-reperfusion injury[J ] . J Surg Res, 2015, 193(2): 942-952. DOI:10.1016/j.jss.2014.09.032.

徐玲, 蔡银链, 许朝祥.氯吡格雷对大鼠心肌缺血/再灌注心肌细胞凋亡及氧自由基的作用及机制[J].中国老年学杂志, 2017, 37(16): 3942-3944.DOI:10.3969/j.issn.1005-9202.2017.16.015.

XU L, CAI Y L, XU C X. Effects of clopidogrel on myocardial apoptosis and oxygen free radicals in myocardial ischemia/reperfusion rats and its mechanism[J]. Chin J Gerontol, 2017, 37(16): 3942-3944.DOI:10.3969/j.issn.1005-9202.2017.16.015.

周縯, 周新巧, 庞庆丰, 等. α2肾上腺素能受体在右美托咪定抑制大鼠肺缺血再灌注损伤时脂质过氧化反应中的作用[J].中华麻醉学杂志, 2017, 37(6):751-753.DOI:10.3760/cma.j.issn.0254-1416.2017.06.029.

ZHOU Y, ZHOU X Q, PANG Q F, et al . Role of α2 adre nergic receptors in dexmedetomidine-induced inhibition of lipid peroxidation during lung ischemia-reperfusion injury in rats[J ] . Chin J Anesthesiol, 2017, 37(6):751-753.DOI:10.3760/cma.j.issn.0254-1416.2017.06.029.

郑兰兰, 张贵和, 高昌俊, 等.远隔缺血预处理对肺损伤患者预后的临床研究Meta分析[J].国际麻醉学与复苏杂志, 2017, 38(2):143-153.DOI:10.3760/cma.j.issn.1673-4378.2017.02.011.

ZHENG L L, ZHANG G H, GAO C J, et al . The effect of remote ischemic preconditioning on clinical outcomes in patients with lung injury: a Meta-analysis of the randomized controlled trials[J ] . Int J Anesthesiol Resuscit, 2017, 38(2):143-153.DOI:10.3760/cma.j.issn.1673-4378.2017.02.011.

王东, 徐岚, 谈鹰, 等.乌司他丁对感染性休克患者的脏器保护作用及感染标志物的影响研究[J].中华医院感染学杂志, 2017, 27(7): 1474-1476.DOI:10.11816/cn.ni.2017-162875.

WANG D, XU L, TAN Y, et al . Effects of ulinastatin on organ protection and infection markers of patients with septic shock[J ] . Chin J Nosocomiol, 2017, 27(7): 1474-1476.DOI:10.11816/cn.ni.2017-162875.

郎志斌, 范晓珍, 邱林, 等.乌司他丁预先给药对CPB下二尖瓣置换术患者心肌损伤时内质网应激的影响[J].中华麻醉学杂志, 2017, 37(6):722-726.DOI:10.3760/cma.j.issn.0254-1416.2017.06.022.

LANG Z B, FAN X Z, QIU L, et al . Effect of ulinastatin pretreatment on endoplasmic reticulum stress during myocardial injury in patients undergoing mitral valve replacement with cardiopulmonary by pass[J ] . Chin J Anesthesiol, 2017, 37(6):722-726.DOI:10.3760/cma.j.issn.0254-1416.2017.06.022.

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