连续臂丛神经阻滞在皮瓣移植缺血再灌注损伤中的作用

大旭 彭(韶关韶康医院，中国 华北理工大学附属医院，中国)
清晨 刘(乐昌市中医院，中国)
秀洋 曹(华北理工大学附属医院，中国)
冠文 邓(韶关韶康医院，中国)

摘要

目的：探讨不同方式的臂丛神经阻滞和镇痛方法对皮瓣移植后缺血再灌注损伤的影响。方法：选取需行皮瓣移植的患者，按随机数字表法分为A、B、C三组。A组：仅进行单次神经阻滞，术后不进行镇痛；B组：行单次神经阻滞和术后静脉镇痛；C组：行连续臂丛神经阻滞，并保留导管予术后镇痛。麻醉后评估各组麻醉效果；记录术后各组VAS评分；记录各组术后1、3、7皮瓣成活情况；ELISA法检测各组麻醉前、术后24h、48h、72h血清超氧化物歧化酶（SOD）、丙二醛（MDA）、白介素-1（IL-1）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）的水平变化。结果：麻醉后20min，各组麻醉效果比较，差异无统计学意义。术后VAS评分，C组明显低于A、B组，C组镇痛效果优于A、B组，差异有统计学意义（P＜0.05）。各组间术后皮瓣情况对比，术后第1天B、C组优于A组；术后第3、7天，C组明显优于A、B组，差异具有统计学意义（P＜0.05）。术前各组SOD、MDA、IL-1、IL-6、TNF-α水平未见明显差异（P＞0.05）；A组术后24h各指标水平较B、C组高（P＜0.05）；C组术后48h各指标水平明显低于A、B组（P＜0.05）；术后72h，C组的各指标水平低于A、B组（P＜0.05）。使用术后镇痛的患者，术后缺血再灌注损伤较未使用者轻；但相比较之下，C组较A、B组明显降低了MDA、IL-1、IL-6、TNF-α的水平，差异具有统计学意义（P＜0.05）。结论：采用连续臂丛神经阻滞，并保留导管进行术后镇痛的方法，可明显减轻术后缺血再灌注损伤反应，提高皮瓣移植的成活率。

关键词

缺血再灌注损伤；皮瓣移植；臂丛神经阻滞；活性氧

参考

Kerrigan C L, Stotland M A. Ischemia reperfusion injury: a review[J]. Microsurgery, 1993, 14(3): 165-175.

Carden D L, Granger D N. Pathophysiology of ischaemia–reperfusion injury[J]. The Journal of pathology, 2000, 190(3): 255-266.

Raedschelders K, Ansley D M, Chen D D Y. The cellular and molecular origin of reactive oxygen species generation during myocardial ischemia and reperfusion[J]. Pharmacology & therapeutics, 2012, 133(2): 230-255.

Downey J M. Free radicals and their involvement during long-term myocardial ischemia and reperfusion[J]. Annual review of physiology, 1990, 52(1): 487-504.

Weyker P D, Webb C A J, Kiamanesh D, et al. Lung ischemia reperfusion injury: a bench-to-bedside review[J].Seminars in cardiothoracic and vascular anesthesia. Sage CA: Los Angeles, CA: SAGE Publications, 2013, 17(1): 28-43.

Jung J E, Kim G S, Chen H, et al. Reperfusion and neurovascular dysfunction in stroke: from basic mechanisms to potential strategies for neuroprotection[J]. Molecular neurobiology, 2010, 41(2): 172-179.

Snoeijs M G J, van Heurn L W E, Buurman W A. Biological modulation of renal ischemia–reperfusion injury[J]. Current opinion in organ transplantation, 2010,15(2): 190-199.

Neary P, Redmond H P. Ischaemia-reperfusion injury and the systemic inflammatory response syndrome[J]. Ischaemia-reperfusion injury, 1999(08): 123-136.

Kaminski K A, Bonda T A, Korecki J, et al. Oxidative stress and neutrophil activation—the two keystones of ischemia/reperfusion injury[J]. International journal of cardiology, 2002, 86(1): 41-59.

Berry C E, Hare J M. Xanthine oxidoreductase and cardiovascular disease: molecular mechanisms and pathophysiological implications[J]. The Journal of physiology, 2004, 555(3): 589-606.

Serrano-Mollar A, Closa D. Arachidonic acid signaling in pathogenesis of allergy: therapeutic implications[J]. Current Drug Targets-Inflammation & Allergy, 2005(02): 151-155.

Yang S, Lian G. ROS and diseases: Role in metabolism and energy supply[J]. Molecular and cellular biochemistry, 2019(05):1-12.

Springer T A. Traffic signals for lymphocyte recirculation and leukocyte emigration: the multistep paradigm[J]. Cell, 1994, 76(2): 301-314.

Sadik C D, Kim N D, Luster A D. Neutrophils cascading their way to inflammation[J]. Trends in immunology, 2011, 32(10): 452-460.

Rossaint J, Margraf A, Zarbock A. Role of platelets in leukocyte recruitment and resolution of inflammation[J]. Frontiers in immunology, 2018(09): 2712.

Duann P, Datta P K, Pan C, et al. Superoxide dismutase mimetic preserves the glomerular capillary permeability barrier to protein[J]. Journal of pharmacology and experimental therapeutics, 2006, 316(3): 1249-1254.

Li C, Jackson R M. Reactive species mechanisms of cellular hypoxia-reoxygenation injury[J]. American Journal of Physiology-Cell Physiology, 2002, 282(2):227-241.

Tsikas D. Assessment of lipid peroxidation by measuring malondialdehyde (MDA) and relatives in biological samples: Analytical and biological challenges[J]. Analytical biochemistry, 2017, 524(08): 13-30.

Li L, Zhao Y, Guo L, et al. Ultrasound guidance enhances the efficiency of brachial plexus block and ameliorates the vascular injury compared with nerve stimulator guidance in hand surgery patients[J]. Journal of Investigative Surgery, 2020, 33(6): 530-535.

Cho S, Kim Y J, Baik H J, et al. Comparison of ultrasound-guided axillary brachial plexus block techniques: perineural injection versus single or double perivascular infiltration[J]. Yonsei medical journal, 2015, 56(3): 838.

Kumari P, Kumar A, Sinha C, et al. Ultrasound-guided continuous costoclavicular brachial plexus block[J]. Indian Journal of Anaesthesia, 2020, 64(7): 637.

DOI: http://dx.doi.org/10.26549/yzlcyxzz.v4i4.7084