CAJ | 학술논문

目的:探讨常规应用止血带是否导致一氧化氮(NO)/内皮素-1(ET-1)失衡和肢体缺血再灌注性肺功能损伤以及无创性肢体缺血预处理(IPC)的干预效果.方法:27例美国麻醉医师协会评分Ⅰ-Ⅱ级择期单侧下肢手术病人随机分为对照组(C组,n=14)和缺血预处理组(IPC组,n=13),分别于上止血带前(T_0)、上止血带后1 h(T_1)和止血带松开后0.5 h(T_2)、2 h(T_3)、6 h(T_4)及24 h(T_5)行动脉血气分析,计算肺泡-动脉氧分压差(P_A-a)DO_2)和肺内分流率(Qs/Qt),测定血NO、ET-1、丙二醛(MDA)和白细胞介素-6(IL-6)水平.结果:与T_0比较,C组患者T_4时动脉血氧分压(PaO_2)明显降低,P_(A-a)DO_2和Qs/Qt显著升高(P<0.01);NO水平及NO/ET-1比)值在T_3始明显降低,T_4时达到最低值(P<0.01),T_5恢复至基础值(P>0.05);ET-1、MDA和IL-6水平至T_3始升高(P<0.01),T_4达到高峰后T_5稍下降.与C组比较,IPC组T_4时ET-1和MDA、T_4-5)时IL-6水平明显降低,T_3-4)时NO水平和NO/ET-1比值显著升高(P<0.05或P<0.01);T_4时P_(A-a)DO_2和Qs/Qt较C组降低(P<0.05),PaO_2无明显升高(P>0.05).结论:常规应用止血带(1.0-1.5 h)可诱发肢体缺血再灌注性肺换气功能损伤,IPC能缓解该过程中的NO/ET-1失衡,从而部分改善患者肺换气功能.
목적:탐토상규응용지혈대시부도치일양화담(NO)/내피소-1(ET-1)실형화지체결혈재관주성폐공능손상이급무창성지체결혈예처리(IPC)적간예효과.방법:27례미국마취의사협회평분Ⅰ-Ⅱ급택기단측하지수술병인수궤분위대조조(C조,n=14)화결혈예처리조(IPC조,n=13),분별우상지혈대전(T_0)、상지혈대후1 h(T_1)화지혈대송개후0.5 h(T_2)、2 h(T_3)、6 h(T_4)급24 h(T_5)행동맥혈기분석,계산폐포-동맥양분압차(P_A-a)DO_2)화폐내분류솔(Qs/Qt),측정혈NO、ET-1、병이철(MDA)화백세포개소-6(IL-6)수평.결과:여T_0비교,C조환자T_4시동맥혈양분압(PaO_2)명현강저,P_(A-a)DO_2화Qs/Qt현저승고(P<0.01);NO수평급NO/ET-1비)치재T_3시명현강저,T_4시체도최저치(P<0.01),T_5회복지기출치(P>0.05);ET-1、MDA화IL-6수평지T_3시승고(P<0.01),T_4체도고봉후T_5초하강.여C조비교,IPC조T_4시ET-1화MDA、T_4-5)시IL-6수평명현강저,T_3-4)시NO수평화NO/ET-1비치현저승고(P<0.05혹P<0.01);T_4시P_(A-a)DO_2화Qs/Qt교C조강저(P<0.05),PaO_2무명현승고(P>0.05).결론:상규응용지혈대(1.0-1.5 h)가유발지체결혈재관주성폐환기공능손상,IPC능완해해과정중적NO/ET-1실형,종이부분개선환자폐환기공능.
AIM: To investigate the effects of non-invasive ischemic preconditioning on nitric oxide (NO)/endothelin-1 (ET-1) imbalance and gas exchange impairment following limb ischemia reperfusion in patients undergoing unilateral lower extremity surgery with tourniquet. METHODS: Twenty-seven patients aged 25-65 years, whose tourniquets duration varied from 1 h to 1.5 h and matched American Society of Anesthesiologists Physical Status Ⅰ-Ⅱ, were randomized into two groups: a control group (n=14) and a ischemic preconditioning group (IPC group, n=13) in which patients received three cycles of 5 min of ischemia/5 min of reperfusion before tourniquet inflation. Radial arterial blood gas, plasma malondialdehyde (MDA) and NO, serum ET-1 and interleukin-6 (IL-6) were measured just before tourniquet inflation(T_0), 1 h after inflation(T_1), and 0.5 h(T_2), 2 h(T_3), 6 h(T_4), 24 h(T_5) after tourniquet deflation. Meanwhile NO/ET-1 ratio, alveolar-arterial oxygen gradient (P_(A-a)DO_2) and intrapulmonary shunt (Qs/Qt) were calculated. RESULTS: In control group, arterial partial pressure of oxygen (PaO_2) were decreased, while P_(A-a)DO_2 and Qs/Qt were increased significantly at T_4 compared to the baselines at T_0 (P<0.01). Plasma NO levels and NO/ET-1 ratios decreased gradually after tourniquets deflation and statistical significances were observed at T_3 (P<0.01) with a valley at T_4 (P<0.01) and recovered to baselines at T_5. Serum ET-1, IL-6 and plasma MDA began to increase remarkably after T_3 (P<0.05 or P<0.01), peaked at T_4 and dropped slightly at T_5. The changes above-mentioned could be well attenuated by the application of IPC (P<0.05 or P<0.01) except PaO_2 (P>0.05). CONCLUSION: Clinical application of unilateral tourniquet within safe time limit (1.5 h) may lead to limb ischemia reperfusion and further pulmonary gas exchange impairment, which could be partially attenuated by the application of IPC via alleviating NO/ET-1 imbalance.