远程缺血预处理对接受肢体手术患者反复使用止血带所致急性肾损伤的肾脏保护作用。
Renoprotective effects of remote ischemic preconditioning on acute kidney injury induced by repeated tourniquet application in patients undergoing extremity surgery.
作者信息
Tao Ziying, Zhang Yang, Kong Erliang, Wei Haili, Li Mingyue, Sun Shuhui, Liu Liwei, Yin Daqing, Feng Xudong
机构信息
Department of Anesthesiology, The 988th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Zhengzhou, China.
Graduate School of Xinxiang Medical University, Xinxiang, China.
出版信息
Front Med (Lausanne). 2024 Dec 20;11:1477099. doi: 10.3389/fmed.2024.1477099. eCollection 2024.
OBJECTIVE
Limb ischemia-reperfusion injury caused by repeated tourniquet application usually leads to acute kidney injury, adversely affecting patient prognosis. This study aimed to investigate the renoprotective effect of remote ischemic preconditioning (RIPC) in patients undergoing extremity surgery with repeated tourniquet application.
METHODS
64 patients were enrolled and randomly divided into an RIPC group and a control group, with 32 patients in each. Pretreatment was administered before surgery, and baseline characteristics were collected. Perioperative surgical characteristics, renal biomarkers, oxidative stress markers, inflammatory factors, and postoperative conditions were recorded.
RESULTS
2 participant were excluded from each group, leaving 30 patients per group. There were no significant differences between the two groups regarding baseline characteristics and perioperative surgical characteristics ( > 0.05). Compared to the control group, the RIPC group showed a significant decrease in BUN and SCr at 48 h postoperatively ( < 0.05). Levels of Cys-C, [TIMP-2] × [IGFBP-7], KIM-1, IL-18, and NGAL were significantly reduced at the first and second tourniquet releases and at 24 h postoperatively in the RIPC group ( < 0.05). From the first tourniquet release to 48 h postoperatively, MDA levels were significantly lower ( < 0.05) and SOD levels were significantly higher ( < 0.05) in the RIPC group compared to the control group. Postoperative conditions did not differ significantly between the groups.
CONCLUSION
RIPC effectively mitigated acute kidney injury caused by repeated tourniquet application, offering a robust method for perioperative renal protection in patients undergoing extremity surgery. Future studies should explore the underlying mechanisms and long-term clinical outcomes of RIPC in broader patient populations.
CLINICAL TRIAL REGISTRATION
目的
反复使用止血带引起的肢体缺血再灌注损伤通常会导致急性肾损伤，对患者预后产生不利影响。本研究旨在探讨远程缺血预处理（RIPC）对接受反复使用止血带的肢体手术患者的肾脏保护作用。
方法
纳入64例患者，随机分为RIPC组和对照组，每组32例。术前进行预处理，并收集基线特征。记录围手术期手术特征、肾脏生物标志物、氧化应激标志物、炎症因子及术后情况。
结果
每组排除2例受试者，每组剩余30例患者。两组在基线特征和围手术期手术特征方面无显著差异（>0.05）。与对照组相比，RIPC组术后48小时血尿素氮（BUN）和血清肌酐（SCr）显著降低（<0.05）。RIPC组在第一次和第二次松开止血带时以及术后24小时，胱抑素C（Cys-C）、[组织金属蛋白酶抑制因子-2（TIMP-2）]×[胰岛素样生长因子结合蛋白-7（IGFBP-7）]、肾损伤分子-1（KIM-1）、白细胞介素-18（IL-18）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平显著降低（<0.05）。从第一次松开止血带到术后48小时，与对照组相比，RIPC组丙二醛（MDA）水平显著降低（<0.05），超氧化物歧化酶（SOD）水平显著升高（<0.05）。两组术后情况无显著差异。
结论
RIPC有效减轻了反复使用止血带引起的急性肾损伤，为接受肢体手术的患者围手术期肾脏保护提供了一种可靠的方法。未来的研究应探讨RIPC在更广泛患者群体中的潜在机制和长期临床结局。
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