Effect Of Sufentanil Precondition On TNF-α And CTnI Induced By Limb Ischemia Reperfusion Injury In The Elderly

Objective:To investigate the effect of sufentanil precondition on TNF-α and c Tn I induced by limb ischemia reperfusion injury with tourniquet in the elderly.Methods:Forty-two patients whose tourniquets duration varied from 1 to 1.5h and matched ASAⅠ~Ⅱ, aged above 65 years old, planned to undergo total knee arthroplasty were randomly divided into two groups: the sufentanil group(group S, n=20)and control group(group C,n=22). A piece of(1ml:50μg) sufentanil injection were diluted to(1ml:5μg) with 0.9%sodium chloride injection.Patients were given corresponding capacity of sufentanil injection according to 0.1μg/kg before tourniquet bound in group S and group C with saline instead.Patients were inserted into the subarachnoid space at the L3-L4 interspace which were injected into 0.75% ropivacaine according to personal circumstances.The highest level of sensory block was T8.Tourniquets were placed when the level of sensory block was stable.The pressure of tourniquet was set between 45-60 k Pa.Interventions were taken to deal with the adverse reactions in the use of tourniquet if necessary.The venous blood samples were collected for the measurements of plasma TNF-α and c Tn I by using enzyme-linked immunosorbent assay(ELISA) before tourniquet bound(T0), and 30min(T1),24h(T2) after tourniquet loosen. Meanwhile the electrocardiogram(ECG), mean arterial pressure(MAP) and heart rate(HR)were recorded.Results:1.The comparison of basic information between the two groups There was no significant difference between the two groups in age,sex ratio,body mass index(BMI) and the time of the tourniquet(P>0.05).2.The comparison of hemodynamic index between the two groups There was no significant difference between the two groups at all points in MAP and HR(P>0.05).3.The comparison of TNF-α and c Tn I between the two groups TNF-α Compared with T0 point, TNF-α at T1 point were increased in two groups(P<0.05).The concentration of TNF-α at T2 was significant lower than T1 between two groups(P<0.05).The level of TNF-α was significant lower in group S than group C at T1 and T2 points(P<0.05).There was no obvious difference of TNF-α at T0 in two groups(P>0.05).c Tn I The concentration of c Tn I was higher at T2 than T0(P>0.05).There was no obvious difference of c Tn I between groups at all points(P>0.05).Conclusion:Sufentanil preconditioning could moderate the change of TNF-α after ischemia reperfusion injury of limbs with tourniquet.Meanwhile,the obvious effect on c Tn I was not observed.