目的：探讨氢溴酸高乌甲素对使用止血带引起的肢体-缺血再灌注期间炎性细胞因子及心肌酶的影响。方法将40例择期行单侧膝关节、近踝及踝关节手术的患者随机分为2组：L 组和 C 组，每组20例。L 组在缺血前10 min 经静脉缓慢（速率为0．2 mL·s－1）推注氢溴酸高乌甲素注射液8 mg（4 mL），C 组在缺血前10 min 以与 L组相同的速率经静脉缓慢推注0．9％氯化钠注射液4 mL。2组在60～90 min 后松开自动气压止血带，行再灌注。2组在自动气压止血带充气前（T0），自动气压止血带放气后10 min（T1）、30 min（T2）抽取静脉血2．0～3．0 mL，分别测定血清肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）水平和肌酸激酶（CK）的活性，同时观察2组在上自动气压止血带前（t0）、松开自动气压止血带前，松开自动气压止血带即刻和松开自动气压止血带5 min（t1）、20 min （t2）的血压（SBP、DBP）、脉搏血氧饱和度（SpO2）及心率（HR）的变化。结果与同组 t0比较，C 组松开自动气压止血带前 SBP、DBP 值均明显升高（均 P ＜0．05）；与同组松开自动气压止血带前比较，C 组松开自动气压止血带即刻SBP、DBP 值均明显下降（均 P ＜0．05）；与 C 组比较，L 组松开自动气压止血带前 SBP、DBP 值均明显下降（均 P ＜0．05）；HR、SpO2值在 t0、松开自动气压止血带前和松开自动气压止血带即刻、t1及 t2的组间、组内比较差异无统计学意义（P ＞0．05）。与同组 T0比较，C 组 T1、T2血清 TNF-α、IL-1β水平及 CK 活性均明显升高（均 P ＜0．05）；与 C 组比较，L 组 T1、T2血清 TNF-α、IL-1β水平及 CK 活性均明显下降（均 P ＜0．05）。结论缺血前10 min 缓慢静脉推注氢溴酸高乌甲素注射液8 mg 能够降低肢体再灌注时血清 CK、TNF-α、I L-1β的含量，且此剂量的高乌甲素能够保证术中患者一般生命体征的平稳。%ABSTRACT:Objective To investigate the effects of lappaconitine hydrobromide on inflammatory cytokines and myocardial enzymes during tourniquet-induced limb ischemia-reperfusion.Methods Forty patients scheduled for unilateral knee joint,near ankle or ankle joint surgery were randomly assigned to receive intravenous infusion of either 4 mL(8 mg)lappaconitine hydrobromide injec-tion(group L)or 4 mL 0.9% sodium chloride injection(group C)10 minutes before tourniquet in-flation at a speed of 0.2 mL·s-1 .After tourniquet inflation for 60-90 minutes,the tourniquet was deflated to allow reperfusion.Venous blood samples(2.0-3.0 mL)were obtained to detect the se-rum levels of tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β)and the activity of crea-tine kinase(CK).In addition,systolic blood pressure,diastolic blood pressure,pulse oxygen satu-ration(SpO2 )and heart rate(HR)were measured before tourniquet inflation(t0 ),before tourni-quet deflation,immediately after tourniquet deflation,5 minutes after tourniquet deflation(t1 ),and 20 minutes after tourniquet deflation(t2 ).Results In group C,the SBP and DBP measured before tourniquet deflation were significantly higher than those measured before tourniquet inflation and those measured immediately after tourniquet deflation(P <0.05),and serum levels of TNF-αand IL-1βand activity of CK measured at T0 were significantly lower than those measured at T1 and T2 .Furthermore,the SBP and DBP measured before tourniquet deflation and serum levels of TNF-αand IL-1βand activity of CK measured at T1 and T2 in group L were significantly lower than those in group C(P <0.05).However,there were no significant differences in the HR and SpO2 among different time points,as well as between group L and group C(P >0.05).Conclusion The slow intravenous injection of 8 mg lappaconitine hydrobromide at 10 minutes before tourni-quet inflation can reduce the serum levels of TNF-αand IL-1βand activity of CK during reperfu-sion and ensure the stable vital signs in patients undergoing surgery.
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