【摘要】：目的:評(píng)價(jià)山莨菪堿對(duì)止血帶誘發(fā)的肢體缺血再灌注損傷和止血帶疼痛的影響。方法:擇期腰麻下行單側(cè)下肢骨科手術(shù)并且應(yīng)用止血帶病人40例,年齡18-68歲,ASAI-II級(jí),術(shù)中止血帶充氣平均時(shí)間為(89.48±10.834)分鐘,分為兩組,每組20人。A組實(shí)驗(yàn)組,山莨菪堿4mg靜脈點(diǎn)滴,C組為對(duì)照組,等容量0.9%氯化鈉注射液代替。1.于止血帶充氣時(shí)(T1),充氣45分鐘(T2)放氣前1分鐘(T3)和放氣后1分鐘(T4)四個(gè)不同時(shí)刻,觀察記錄血壓和心率。2.在術(shù)前應(yīng)用止血帶前(T0)、止血帶放氣后5分鐘(T5)、止血帶放氣后30分鐘(T6)抽取上臂肘正中靜脈血3ml,測(cè)定并計(jì)算各時(shí)間段內(nèi)經(jīng)止血帶作用MDA的增加量。3.從止血帶充氣到放氣時(shí)間段內(nèi),若患者主訴應(yīng)用止血帶的部位疼痛,則記錄為發(fā)生止血帶疼痛的例數(shù),并總結(jié)每組里發(fā)生止血帶疼痛的例數(shù)。結(jié)果:1.與C組比較,A組T1時(shí)刻血壓高于C組(P0.05);T2-4兩組血壓無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);與C組比較,A組T1-4時(shí)刻心率差別無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.與C組比較,從應(yīng)用止血帶開(kāi)始到放氣5分鐘內(nèi)A組血清MDA的增加量低于C組(P0.05),從應(yīng)用止血帶開(kāi)始到放氣30分鐘內(nèi)A組血清MDA增加量低于C組(P0.05)。3.兩組出現(xiàn)止血帶疼痛的例數(shù)差別有統(tǒng)計(jì)學(xué)意義,A組低于C組(P0.05)。結(jié)論:1.山莨菪堿能減少缺血再灌注引起的自由基的增加量,減輕肢體缺血再灌注自由基的損傷,對(duì)于止血帶LIRI有一定的影響。2.山莨菪堿能減少止血帶疼痛的發(fā)生次數(shù)。
[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 鹵10.834) minutes, and the mean inflation time of tourniquet was (89.48 鹵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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R614

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