Application Of Ischemic Postconditioning In Acute Superior Mesenteric Artery Embolism

Objective:To study the effects of post-ischemic adaptation on oxidative and inflammatory responses to intestinal ischemia-reperfusion injury,to determine whether postischemic adaptation can alleviate human intestinal ischemia-reperfusion injury,thereby improving the prognosis of patients with superior mesenteric artery embolism,improving the treatment rate and reducing mortality.Methods:?1?54 cases of acute mesenteric artery embolism from July 2016 to April 2019in Yuhuangding Hospital of Yantai City were collected.They were randomly divided into blank control group?18 cases?,in situ post-ischemic adaptation group 1?18 cases?and in situ post-ischemic adaptation group 2?18 cases?.Superior mesenteric artery thrombectomy was performed in all three groups.In the blank control group,the abdominal cavity was closed after operation and the operation was completed.In situ ischemic postconditioning group 1,ischemic postconditioning was performed before intestinal blood supply was restored?Superior mesenteric artery occlusion for 1 minute,open reperfusion for 1 minute,totally three cycles?,In situ ischemic postconditioning group 2,ischemic postconditioning was performed before intestinal blood supply was restored?Superior mesenteric artery occlusion for 3 minute,open reperfusion for 3 minute,totally three cycles???2?Inclusion criteria:?1?Superior mesenteric artery embolism was confirmed by enhanced CT or superior mesenteric artery angiography.?2?Partial superior mesenteric artery embolism was excluded.?3?Failure of thrombectomy during operation was excluded.?4?Patients with total intestinal necrosis due to prolonged ischemia were excluded.?5?Patients who had been treated outside the hospital were excluded.?3?5 ml of peripheral venous blood was taken before the recanalization of superior mesenteric artery and 2,4 and 12 hours after the recanalization of superior mesenteric artery.Measuring serum procalcitonin?PCT?,myeloperoxidase?MPO?and lipid peroxide?MDA?.To compare the absolute changes of serum procalcitonin?PCT?,myeloperoxidase?MPO?,lipid peroxides?MDA?with preoperative baseline values among the three groups.Results:?1?Absolute changes of serum procalcitonin?PCT?,myeloperoxide?MPO?and lipid peroxide?MDA?in situ post-ischemic adaptation group 1 were lower than those in blank control group?2,4 and 12 hours after intestinal blood flow recanalization p ₁<0.05?.?2?Absolute changes of serum procalcitonin?PCT?,myeloperoxide?MPO?and lipid peroxide?MDA?in situ post-ischemic adaptation group 2 were lower than those in blank control group?2,4 and 12 hours after intestinal blood flow recanalization p₂<0.05?.?3?Absolute changes of serum procalcitonin?PCT?,myeloperoxide?MPO?and lipid peroxide?MDA?in situ post-ischemic adaptation group 2 have not much difference than those in situ post-ischemic adaptation group 2?2,4 and 12 hours after intestinal blood flow recanalization p₃>0.05?.Conclusions:?1?Ischemic postconditioning has the effect of increasing the antioxidation and reducing inflammatory reaction of intestinal tissue,It can reduce the intestinal ischemia-reperfusion injury.?2?The ability of intestinal tissue to reduce antioxidant and inflammatory reaction was not further improved by prolonging the adaptation time after ischemia.