山莨菪碱对下肢手术止血带并发症的影响

发布时间：2019-04-21 14:45

【摘要】：目的:评价山莨菪碱对止血带诱发的肢体缺血再灌注损伤和止血带疼痛的影响。方法:择期腰麻下行单侧下肢骨科手术并且应用止血带病人40例,年龄18-68岁,ASAI-II级,术中止血带充气平均时间为(89.48±10.834)分钟,分为两组,每组20人。A组实验组,山莨菪碱4mg静脉点滴,C组为对照组,等容量0.9%氯化钠注射液代替。1.于止血带充气时(T1),充气45分钟(T2)放气前1分钟(T3)和放气后1分钟(T4)四个不同时刻,观察记录血压和心率。2.在术前应用止血带前(T0)、止血带放气后5分钟(T5)、止血带放气后30分钟(T6)抽取上臂肘正中静脉血3ml,测定并计算各时间段内经止血带作用MDA的增加量。3.从止血带充气到放气时间段内,若患者主诉应用止血带的部位疼痛,则记录为发生止血带疼痛的例数,并总结每组里发生止血带疼痛的例数。结果:1.与C组比较,A组T1时刻血压高于C组(P0.05);T2-4两组血压无统计学意义(P0.05);与C组比较,A组T1-4时刻心率差别无统计学意义(P0.05)。2.与C组比较,从应用止血带开始到放气5分钟内A组血清MDA的增加量低于C组(P0.05),从应用止血带开始到放气30分钟内A组血清MDA增加量低于C组(P0.05)。3.两组出现止血带疼痛的例数差别有统计学意义,A组低于C组(P0.05)。结论:1.山莨菪碱能减少缺血再灌注引起的自由基的增加量,减轻肢体缺血再灌注自由基的损伤,对于止血带LIRI有一定的影响。2.山莨菪碱能减少止血带疼痛的发生次数。
[Abstract]:Objective: to evaluate the effect of anisodamine on tourniquet-induced limb ischemia-reperfusion injury and tourniquet pain. Methods: forty patients (18 years old, 68 years old, ASAI-II grade) undergoing unilateral lower limb orthopedic surgery under elective spinal anesthesia were divided into two groups: the mean inflation time of tourniquet during operation was (89.48 卤10.834) minutes, and the mean inflation time of tourniquet was (89.48 卤10.834) minutes. Group A, anisodamine 4mg intravenous drip, group C as control group, equal volume 0.9% sodium chloride injection instead of .1.1.A group, anisodamine 4mg intravenous drip, C group as control group, equal volume 0.9% sodium chloride injection instead. Blood pressure and heart rate were recorded at different time points of tourniquet inflation (T1), 45 minutes (T2) before exhalation (T3) and 1 minute after exhalation (T4). Before the application of tourniquet (T0), 5 minutes after tourniquet discharge (T5) and 30 minutes after tourniquet discharge (T6), 3 ml of blood was drawn from the median middle vein of the upper elbow to measure and calculate the increase of the action of the tourniquet on MDA in each period of time. 3. During the period from tourniquet inflation to ventilation, if the patient complained of pain in the area where the tourniquet was used, the number of cases of tourniquet pain was recorded, and the number of cases of tourniquet pain in each group was summarized. Results: 1. Compared with group C, the blood pressure in group A at T1 was higher than that in group C (P0.05), and there was no significant difference in blood pressure between group A and group C (P0.05), and there was no significant difference in heart rate between group A and group C (P0.05). Compared with group C, the increase of serum MDA in group A was lower than that in group C in 5 minutes from the beginning of tourniquet application to degassing (P0.05), and the increase of serum MDA in group A was lower than that in group C within 30 minutes from the beginning of use of tourniquet to the discharge of gas (P0.05). The number of patients with tourniquet pain in group A was lower than that in group C (P0.05). Conclusions: 1. Anisodamine can reduce the increase of free radicals induced by ischemia-reperfusion and alleviate the injury of limb ischemia-reperfusion free radicals. Anisodamine has a certain effect on the LIRI of tourniquet. 2. Anisodamine reduces the frequency of tourniquet pain.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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