Effects Of Creatine Phosphate Sodium Preconditioning On Skeletal Muscle Ischemia Reperfusion Injury Of Patients Undergoing Knee Arthroscopic Surgery

Objective Skeletal muscle ischemia-reperfusion(IR) injury is usually seen in serious trauma, limb replantation, the osteofascial compartment syndrome, long term tourniquet inflation. Now think ischemia-reperfusion injury have important relationship with energy metabolism. Creatine phosphate sodium as a kind of exogenous energy mixture, has been used in clinical effect on heart and cerebral protection. The effect on skeletal muscle has not yet been reported. The study intends to investigate the effect of creatine phosphate sodium on skeletal muscle ischemia reperfusion injury of patients undergoing knee arthroscopic surgery.Methods Sixty patients which American society of anesthesiologists(ASA) grade I to II with knee arthroscopic surgery were randomly assigned into two groups: control group(n=30) and creatine phosphate sodium( CP) pretreatment group(n=30). An intravenous line was accessed in the arm. All patients were monitored with BP, HR,SPO2 and BIS after entered the operation room. In group C, creatine phosphate sodium(30 mg/kg) in 100 ml normal saline was infused over 30 min starting from the beginning of operation. In control group NS 100 ml was infused instead of CP.Midazolam(50μg/kg), etomidate(0.3 mg/kg), sufentanil(0.5μg/kg) and cisatracurium(0.2mg/kg) were used through intravenous injection during anesthesia induction. The patients in all groups inserted laryngeal mask airway after three minutes, then supported with mechanical ventilation. The ventilated parameters were adjusted to maintain tidal volume between 8~10ml/Kg, breathing rate 10 times,PETCO2 between 4.7~6.0Kpa. Propofol and remifentanil were infused to maintain anesthesia complemented in total intravenous anesthesia. BIS was adjusted in 40~60 during the surgery. The muscle relaxation was maintained with intermittent injection of cisatracurium. Respectively, before tourniquet inflation(T1), before tourniquet release(T2), after tourniquet release in 30 minutes(T3), 1h after tourniquet release(T4) in venous blood, detection of serum IL-1, IL-6, LDH, MDA and SOD level. Statistical analysis was performed by using SPSS17.0 software package. P<0.05 was considered statistically significant. Calculated date was with (?)±s test. Repeated measures analysis of variance was used in intra-group comparison. Comparison between two groups was done with independence sample T-test.Results The general information(age, gender, BMI, tourniquet cross-clamp time,operative time) had no significant difference between two groups(P>0.05). Compared with I group, C group had IL-1, IL-6, LDH, MDA were significantly decreased(P<0.05), SOD was significantly increased(P<0.05).Conclusion Our research demonstrated that pretreatment with creatine phosphate sodium can reduce lipid peroxidation, eliminate oxygen free-radicals and reduce the mitochondrial damage. Pretreatment with creatine phosphate sodium can protect skeletal muscle against ischemia reperfusion injury in patients.