Clinical Study Of Creatine Phosphate Sodium And Edaravone Pretreatment For Combating Orthopedic Anesthesia Patient Tourniquet Injury

Objective:To advance intravenous injection creatine phosphate sodium and free radical scavenger edaravone observe accepted lower limb orthopedic surgery and intraoperative tourniquet required hemodynamic changes in patients,before and after application of a tourniquet tourniquet serum changes of superoxide dismutase and malondialdehyde.Discussion feasibility by creatine phosphate sodium and radical scavenger edaravone for lower limb orthopedic surgery.Methods:The study included 40 patients under general anesthesia for elective lower limb orthopedic surgery and the patient required surgery tourniquet,ASA grade Ⅰ-Ⅱ,aged18-60 years,tourniquet time is less than 90 minutes.Random number table,randomly divided into four groups(n = 10): control group(group D),creatine phosphate sodium pretreatment group(group C),edaravone pretreatment(group E),edaravone and creatine phosphate sodium joint preconditioning(group EC).All general anesthesia by tracheal intubation,target-controlled infusion of propofol and remifentanil anesthesia maintained.Exclusion criteria: ASA grade Ⅲ-Ⅳ,Heart 、 lung 、 liver and renal dysfunction,of edaravone and creatine phosphate sodium allergy.Obesity(BMI> 30Kg/ m~2),anemia(Hb<100g/l),history of hypertension and diabetes,chronic lower limbischemic disease,preoperative week application oxidant or anti-oxidants and other drugs.Maintenance of anesthesia: target-controlled infusion of propofol and remifentanil,according to the depth of anesthesia(BIS value was maintained at 40-60)and circulation,adjust propofol and remifentanil infusion rate(propofol concentration range2-2.5ug / kg,remifentanil effect-concentration setting range 1.5-2ng / kg).Intraoperative fluid velocity is maintained at 6-8ml / kg / h(Crystal Liquids and Colloidal Liquids= 2: 1).Monitoring Indicators: clinical indicators: heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),bispectral index(BIS),end-tidal carbon dioxide partial pressure(Pet CO2),heart rate and systolic blood pressure product(RPP).Laboratory indexes: serum superoxide dismutase(SOD),malondialdehyde(MDA).Monitoring point: baseline(T0),a pneumatic tourniquet immediately(T1),after every15 minutes of recording(T2,T3,T4,T5),2 minutes after the tourniquet release(T6),5minutes after tourniquet release(T7),10 minutes after the tourniquet release(T8),30 minutes after the tourniquet release(T9).Respectively before tourniquet T0 and after tourniquet release T9 points collect venous blood sample.Result:(1)Compared with D group,C group and EC group at T5 HR was significantly decreased 、 at T2~T5 RPP decreased significantly and at T6~T7 PetCO2decreased(P<0.05).(2)Compared with D group,C group、E group and EC group at T9 SOD increased and MDA decreased(P<0.05).Compared with C group,EC group at T9 SOD activity and MDA content are different than those in group C(P<0.05).Conclusion:Creatine phosphate sodium and edaravone pretreatment can improve lower limb surgery patients increased heart rate and reduce myocardial oxygen consumption duringtourniquet application;capable of reducing anaerobic metabolism generated by tourniquet;at the same time can significantly reduce the body content of malondialdehyde and reduce superoxide dismutase consumption.