Cheng Y J, Chien C T, Chen C F
Department of Anaesthetics, College of Medicine, National Taiwan University, Taipei, Republic of China.
J Bone Joint Surg Br. 2003 Jul;85(5):679-82.
Free radicals, such as reactive oxygen species (ROS) which are released abruptly after deflation of an ischaemic tourniquet, cause reperfusion injuries. Ischaemic precondition (IPC), however, can reduce the injury. In clinical practice, the sequential application and release of tourniquets is often used in bilateral total knee replacement (TKR) to obtain a clearer operative field, but the effects on the production of free radicals and lipid peroxidation have not been studied. In this study, we have observed the production of free radicals and the subsequent lipid peroxidation in bilateral TKR with sequential application of a tourniquet to examine the effect of IPC. Patients undergoing elective TKR under intrathecal anaesthesia were studied. Blood samples were obtained after spinal anaesthesia, one minute before and five and 20 minutes after release of each tourniquet. We used the lucigenin chemiluminescence analysis and the phosphatidylcholine hydroperoxide (PCOOH) assay to measure the production of ROS and lipid peroxidation. Our results showed that production of ROS significantly increased at five and 20 minutes after release of the first tourniquet and at five minutes after release of the second tourniquet, but returned to normal at 20 minutes after the second reperfusion. The peak production of ROS was at 20 minutes after the first reperfusion; lipid peroxidation did not change significantly. We conclude that in spite of significant production of ROS after the release of tourniquet, the IPC phenomenon occurs during bilateral TKR with sequential application of a tourniquet.
自由基，如缺血性止血带放气后突然释放的活性氧（ROS），会导致再灌注损伤。然而，缺血预处理（IPC）可以减轻这种损伤。在临床实践中，双侧全膝关节置换术（TKR）常采用依次应用和松开止血带的方法来获得更清晰的术野，但对自由基产生和脂质过氧化的影响尚未有研究。在本研究中，我们观察了双侧TKR中依次应用止血带时自由基的产生及随后的脂质过氧化情况，以检验IPC的作用。对在鞘内麻醉下接受择期TKR的患者进行了研究。在脊麻后、每次松开止血带前1分钟、松开后5分钟和20分钟采集血样。我们使用光泽精化学发光分析和磷脂酰胆碱氢过氧化物（PCOOH）测定法来测量ROS的产生和脂质过氧化。我们的结果显示，在松开第一个止血带后5分钟和20分钟以及松开第二个止血带后5分钟时，ROS的产生显著增加，但在第二次再灌注后20分钟恢复正常。ROS的产生峰值出现在第一次再灌注后20分钟；脂质过氧化没有显著变化。我们得出结论，尽管松开止血带后ROS大量产生，但在双侧TKR依次应用止血带的过程中会出现IPC现象。
