Effects of butorphanol pretreatment on myocardial injury induced by limb ischemia/reperfusion / 中国医师进修杂志

ABSTRACT

Objective To investigate the effects of butorphanol pretreatment on myocardial injury induced by limb ischemia/reperfusion.Methods Forty patients with distal lower extremity orthopedic surgery (ASA Ⅰ or Ⅱ) were divided into two groups by random digits table method with 20 cases each:butorphanol group and control group.Epidural anesthesia was selected in all patients.In butorphanol group,patients were given butorphanol 0.04 mg/kg intravenously 15 min before tourniquet.In control group,equal volume of normal saline was infused at the same time.Blood samples were taken from jugular vein before tourniquet (T0),then 5 min(T1),2 h (T2),6 h (T3),12 h (T4) and 24 h (T5) after the second reperfusion of tourniquet.The serum creatine kinase isoenzyme MB (CK-MB),cardiac troponin Ⅰ (cTnI),tumor necrosis factor-α (TNF-α) and malondialdehyde (MDA) levels were determined.Results Compared with those at T0,the serum C K-MB levels were increased at T2-T5,the serum cTnI,MDA,TNF-α levels were increased at T1-T5 in control group,and there were significant differences (P ＜ 0.05).Compared with those at T0,the serum CK-MB levels were increased at T3,T4,the serum TNF-α levels were increased at T1-T3,the serum cTnI levels were increased at T1-T5 in butorphanol group,and there were significant differences (P ＜ 0.05).Compared with those in control group,the serum CK-MB levels were decreased at T2-T5 [(20.2 ± 5.0) U/L vs.(35.3 ±6.8) U/L,(32.3 ±3.7) U/L vs.(48.6 ±8.5) U/L,(29.5 ±5.4) U/L vs.(51.5 ±8.0) U/L,(22.2 ±4.8) U/L vs.(33.7 ±6.7) U/L],the serum cTnI,TNF-α levels were decreased at T1-T5 [(0.158 ± 0.016) μg/L vs.(0.278 ±0.021) μg/L,(0.169 ±0.036) μg/L vs.(0.332 ± 0.062) μg/L,(0.357 ±0.049) μg/L vs.(0.623 ±0.083) μg/L,(0.178 ±0.045) μg/L vs.(0.383 ±0.059) μg/L,(0.138 ±0.016) μg/L vs.(0.263 ±0.023) μg/L; (1.63 ±0.13) μg/L vs.(2.12 ±0.08) μg/L,(1.69 ± 0.08) μ g/L vs.(2.28 ± 0.09) μ g/L,(1.63 ± 0.09) μ g/L vs.(2.25 ± 0.07) μ g/L,(1.23 ± 0.14) μμg/Lvs.(1.93±0.12) μg/L,(1.13±0.15) μμg/Lvs.(1.79±0.07) μμg/L],theserumMDAlevelswere decreased at T1-T4 [(4.82 ±0.53) nmol/L vs.(6.68 ±0.67) nmol/L,(4.99 ±0.61) nmol/L vs.(7.59 ±0.72) nmol/L,(5.02 ±0.43) nmol/L vs.(7.54 ±0.63) nmol/L,(4.52 ±0.55) nmol/L vs.(6.52 ±0.47) nmol/L] in butorphanol group,and there were significant differences (P ＜0.05).Conclusion Butorphanol pretreatment can improve the serum CK-MB,cTnI levels,and has a protective role for myocardial injury induced by limb ischemia/reperfusion.