河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (2): 230-235.doi: 10.3969/j.issn.1007-3205.2023.02.021

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布托啡诺联合氟比洛芬酯预防止血带致肢体缺血再灌注损伤临床观察

  

  1. 1.河北省张家口市第二医院麻醉科，河北 张家口 075000；2.河北北方学院病生教研室，河北 张家口 075000；
    3.河北北方学院档案馆，河北 张家口 075000

  • 出版日期:2023-02-25 发布日期:2023-02-28
  • 作者简介:李海英（1970-），女，河北张家口人，河北省张家口市第二医院主治医师，医学硕士，从事缺血再灌注损伤诊治研究。
  • 基金资助:
    张家口市重点研发计划项目（2121084D）

Clinical observation on butorphanol combined with flurbiprofen axetil in the prevention of tourniquet-induced ischemia-reperfusion injury of the limbs

  1. 1.Department of Anesthesiology, the Second Hospital of Zhangjiakou City, Hebei Province, Zhangjiakou 
    075000, China; 2.Department of Medical Students, Hebei North University, Zhangjiakou 075000, China； 
    3.Archives of Hebei North University, Zhangjiakou 075000, China
  • Online:2023-02-25 Published:2023-02-28

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摘要： 目的 探讨布托啡诺联合氟比洛芬酯预防止血带致肢体缺血再灌注损伤（ischemical reperfusion injury，IRI）作用。
方法 将河北省张家口市第二医院行人工单膝置换术患者120例随机分为对照组、布托啡诺组、氟比洛芬酯组、联合组4组，各30例。比较4组麻醉前5 min（T0）、上止血带前5 min（T1）、松止血带前5 min（T2）、松止血带后30 min（T3）心率（heart rate，HR）、平均动脉压（mean arterial pressure，MAP）、动脉血氧饱和度（arterial oxygen saturation，SpO2）、丙二醛（malondialdehyde，MDA）、超氧化物歧化酶（superoxide dismutase，SOD）、肿瘤坏死因子α（tumor necrosis factor-α，TNF-α)、白细胞介素8（interleukin-8，IL-8）、白细胞介素6（interleukin-6，IL-6）、患肢腓肠肌周径、膝关节周径及股四头肌周径增加率以及术前、术后12 h、术后24 h、术后72 h疼痛视觉模拟评分法（visualan alogue scale，VAS）评分。
结果 4组不同时点间、组间、组间·时点间HR、MAP、SpO2比较差异无统计学意义（P＞0.05）；对照组、布托啡诺组、氟比洛芬酯组T1、T2、T3 MDA均高于T0，SOD均低于T0（P＜0.05）；联合组T1、T2、T3 MDA低于布托啡诺组、氟比洛芬酯组、对照组，SOD高于布托啡诺组、氟比洛芬酯组、对照组（P＜0.05）；对照组、布托啡诺组、氟比洛芬酯组T1、T2、T3 TNF-α、IL-8、IL-6高于T0（P＜0.05）；联合组T1、T2、T3 TNF-α、IL-8、IL-6低于布托啡诺组、氟比洛芬酯组、对照组（P＜0.05）；联合组患肢腓肠肌周径、膝关节周径及股四头肌周径增加率低于布托啡诺组、氟比洛芬酯组、对照组（P＜0.05）；联合组术后12 h、术后24 h、术后72 h疼痛VAS评分低于布托啡诺组、氟比洛芬酯组、对照组（P＜0.05）。
结论 布托啡诺联合氟比洛芬酯可减轻止血带后IRI所致炎症反应、氧化应激，预防肢体IRI，缓解小腿肿胀程度，减轻患者疼痛，有利于术后恢复。


关键词: 再灌注损伤, 布托啡诺, 氟比洛芬酯

Abstract: Objective To investigate the effect of butorphanol combined with flurbiprofen axetil in preventing tourniquet-induced ischemia-reperfusion injury (IRI)of the limbs. 
Methods A total of 120 patients undergoing unilateral artificial knee athroplasty inthe Second Hospital of Zhangjiakou City, Hebei Province, were randomly divided into four groups: control group, butorphanol group, flurbiprofen axetil group and the combination group, with 30 patients in each group. Heart rate (HR) and mean arterial pressure (MAP）, arterial oxygen saturation (SpO2), malondialdehyde (MDA), superoxide dismutase (SOD), tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), interleukin-6 (IL-6), increase rate of gastrocnemius muscle circumference of affected limb, knee joint circumference and quadriceps muscle circumference at 5 min before anesthesia (T0), at 5 min before tightening the tourniquet (T1), at 5 min before tourniquet loosening (T2), and at 30 min after tourniquet loosening (T3), and visual analogue scale (VAS) score before operation, and at 12 h, 24 h, and 72 h after operation were compared between two group. 
Results The difference of interaction between groups, time points and time points between groups was statistically significant with respect to HR, MAP and SpO2(P>0.05). In the control group, butorphanol group and flurbiprofen axetil group, MDA at T1, T2 and T3 was higher than that at T0, while SOD was lower than that at T0 (P＜0.05). MDA at T1, T2, and T3 in the combination group were lower than those in the butorphanol group, flurbiprofen axetil group and control group, and the SOD was higher than that in the butorphanol group, flurbiprofen axetil group and control group (P＜0.05). TNF-α, IL-8, IL-6 at T1, T2, and T3 in the control group, butorphanol group, and flurbiprofen axetil group were higher than those at T0 (P＜0.05). TNF-α, IL-8 and IL-6 at T1, T2, and T3 in the combination group were lower than those in the butorphanol group, flurbiprofen axetil group and control group (P＜0.05). The increase rate of gastrocnemius muscle circumference of the affected limb, knee joint circumference and quadriceps muscle circumference in the combination group were lower than those of but orphanol group, flurbiprofen axetil group and control group (P＜0.05). The pain VAS score at 12 h, 24 h, and 72 h in the combination group was lower than that in the butorphanol group, flurbiprofen axetil group and control group (P＜0.05). 
Conclusion Butorphanol combined with flurbiprofen axetil can reduce the inflammatory response and oxidative stress caused by tourniquet induced IRI, prevent limb IRI, relieve the swelling degree of the calf, and reduce the pain of patients, which is conducive to postoperative recovery. 


Key words: reperfusion injury, butorphanol, flurbiprofen axetil

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