[舒芬太尼对止血带引起肢体缺血再灌注损伤的影响] 肢体缺血再灌注最易引发损伤的器官

　　【摘要】 目的 研究舒芬太尼对使用止血带患者缺血再灌注后血浆一氧化氮(NO)及内皮素(ET)的影响。 方法 选取择期行单侧下肢手术患者60例，术中均使用止血带，随机分为对照组(C组)及舒芬太尼组(S组)，每组各30例，S组在止血带充气前给予舒芬太尼0.2 μg/kg，C组给予相等剂量的生理盐水。于止血带充气前(T0)、止血带开放即刻(T1)、止血带开放15 min(T2)、止血带开放30 min(T3)、止血带开放1 h(T4)及止血带开放2 h(T5)分别取血测NO及ET，并记录止血带开放即刻、1、5、10 min及15 min的心率(HR)、收缩压(SBP)及舒张压(DBP)。 结果 两组患者T2-T5时间点两组NO及ET水平较T0及T1均有显著差异( P <0.05)，S组NO高于同时间点C组( P <0.05)，而T2～T4 ET低于同时间点C组( P <0.05)，开放1、5、10 min及15 min两组的HR均比开放即刻增加( P <0.05)，而SBP及DBP则降低( P <0.05)，S组开放5 min及10 min时HR较C组低( P <0.05)，而开放5、10及15 min时的SBP及DB P 均较C组高( P <0.05)。 结论 舒芬太尼能减轻止血带后缺血再灌注损伤所致的NO及ET水平波动，有一定的保护作用。
　　【关键词】
　　舒芬太尼；缺血再灌注损伤；止血带；一氧化氮；内皮素
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　　The influence of sufentanil to ischemic reperfusion injury of limbs after using tourniquet in patients
　　
　　XU Xiang-hui, ZHANG Jin-zhi, ZHANG Dong-mei, et al.Department of Anethesiology, Peking University Shenzhen Hospital, Shenzhen 518036, China
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　　【Abstract】 Objective
　　To investigate the changes of NO and ET levels influenced by sufentanil to ischemic reperfusion injury of limbs after using tourniquet in patients. Methods Sixty cases undergoing lower limb surgery with tourniquet were chosen and divided into two groups with thirty cases each randomly. Group S was received sufentanil 0.2 μg/kg before tourniquet inflation，while group C was received NS. Blood samples were collected at before inflation(T0), tourniquet releasing(T1), 15 minutes after releasing(T2),30 minutes after releasing(T2), 1 hour after releasing (T4) and 2 hour after releasing (T5) to detect NO and ET. HR, SBP and DBP were recorded at just releasing, 1 minute after releasing, 5 minutes after releasing, 10 minutes after releasing and 15 minutes after releasing. Results NO and ET of two groups at T2～T5 were significantly different compared to T0 and T1 ( P <0.05), NO of group S was higher at T2-T5 ( P <0.05) while ET was lower at T2～T4 ( P <0.05). HR of two groups were increased ( P <0.05) after releasing while SBP and DBP were decreased ( P <0.05). HR of group S was lower when 5 minutes and 10 minutes after releasing ( P <0.05), but SBP and DBP of group S was higher when 5 minutes, 10 minutes and 15 minutes after releasing ( P <0.05). Conclusion Sufentanil could moderates the changes of NO and ET after ischemic reperfusion injury of limbs of using tourniquet and appears protection.
　　【Key words】
　　Sufentanil; Ischemic reperfusion injury; Tourniquet;Nitric oxide;Endothelin