Effect Of Sodium Phosphocreatine Pretreatment On Tourniquet Induced Lung Injury

Objective: Through the pre injection of sodium phosphocreatine before tourniquet,to observe the change of lung surfactant protein D in early arterial blood by tourniquet,to evaluate the preventive and therapeutic effects of phosphocreatine sodium preconditioning on tourniquet induced lung injury.Method: In this study,elective lower extremity anesthesia traumatic Department of orthopedics,age 30-40 years old,ASA classification for I-II class 30 patients,according to the principle of random patients were divided into A group:control group and B group:sodium phosphocreatine pretreatment group.After entering the operation room patients were connected with non-invasive blood pressure,electrocardiogram and pulse oxygen saturation,and peripheral vein,the radial artery puncture catheter was used to monitor the invasive arterial pressure and blood sample collection under local anesthesia.After the preparations were completed,the B group dissolved the phosphocreatine sodium 2G in 100ml0.9% sodium chloride and infused it through the peripheral vein within 30 minutes,and group A with 0.9% sodium chloride instead of pure 100 ml.The 100 ml liquid after induction of anesthesia: followed by intravenous injection of 0.03mg/kg midazolam,0.2mg/kg CIS atracurium,0.25mg/kg etomidate,0.6ug/kg sufentanil.The muscle completely relaxed after laryngeal mask insertion,connecting mechanical ventilation anesthesia machine,the set tidal volume is 8ml/kg,respiratory frequency was 12 times /min,respiratory ratio is 1:2,and according to the value of the end tidal carbon dioxide partial pressure to adjust the tidal volume to maintain between 35-40 mm Hg.Propofol and remifentanil were used to maintain anesthesia during operation,and the infusion speed of propofol and remifentanil was adjusted according to the depth of anesthesia(BIS value maintained at 40-60)and circulation.The systolic pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)and mean arterial pressure(MAP)were monitored and recorded during the patient's entrance to the operation room(T0),tourniquet inflated immediately(T1),the tourniquet is inflated for 30 minutes(T2),tourniquet inflated for 1 hours(T3),tourniquet deflated 1 minutes(T4),the tourniquet was released 30 minutes(T5)and after removal of the laryngeal mask,anterior chamber(T6).At the same time,the radial arterial blood was extracted at three time points above T0,T5 and T6 for detecting pulmonary surfactant protein D(SP-D)and the arterial blood p H,arterial oxygen partial pressure(Pa O2),arterial carbon dioxide partial pressure(Pa CO2),and the arterial blood oxygen partial pressure difference PO2(A-a)and respiratory index(RI)were calculated.Result: 1,The two groups of different time SP-D comparison In the group,the difference between the A group and the B group was statistically significant(P<0.05),and when the T5 was significantly higher than the T0,the T6 was significantly higher than that of T5.Between groups,at T0,the difference between the two groups was not statistically significant(P>0.05);at T5 and T6,the difference between the two groups was statistically significant(P<0.05),and the results showed that the A group was significantly higher than that of the B group.2,the two groups of different time PH and Pa CO2 comparison There was no significant difference in PH and Pa CO2 between the two groups(A group and B group).3,the two groups of different time Pa O2 comparison Between groups,when T0,the difference between the two groups was not statistically significant;T5 and T6,the difference between the two groups was statistically significant(P<0.05),both showed B group was significantly higher than the A group.From within the group,A group,B group and the difference was statistically significant(P<0.05),the two groups were compared to each other,T5 Pa O2 was significantly higher than that of T0 and T6,the difference was statistically significant(P<0.05),no statistically significant differences between T6 and T0.4,the two groups of PO2(A-a),RI comparison When comparing T0 between groups,there was no significant difference in PO2(A-a)and RI between group A and group B.At T6,group A,PO2(A-a)and RI were higher than those of group B,and the difference was statistically significant(P<0.05).Conclusion: In patients with lower extremity traumatic Department of orthopedics surgery,pretreatment with phosphocreatine sodium can inhibit lung injury induced by ischemia reperfusion in a certain extent,it can protect the lung ventilation function induced by tourniquet.