The Effect Of Preoperative Oral Carbohydrate On Ischemia-reperfusion Injury Induced By Total Knee Arthroplasty Tourniquet

Objective To investigate whether oral carbohydrate before surgery can reduce the ischemia-reperfusion injury induced by knee arthroplasty tourniquet.Method A total of 40 patients undergoing unilateral total knee arthroplasty in People’s Hospital of Ningxia Hui Autonomous Region from January 2019 to August2019 were selected,and they were randomly divided into normal fasting group（Group L）and preoperative oral carbohydrate group（Group S）,20 patients in each group.Group L:fasting began at 22:00pm one day before surgery,and drinking water was not restricted until 2 hours before surgery.Group S:fasting food at 22:00pm one day before surgery,oral carbohydrate（energy 320kal）which had prepared by nutrition department 2 hours before surgery,rinsing with warm water（5ml/kg）,diluting to400ml at most,then drank up directly within 10min,no restriction of drinking water until 2 hours before surgery.All patients were operated by the same surgeon under isobaric combined fine needle spinal anesthesia.General information of patients were recorded,to observe and compare the incidence of thirst,hunger,recording MAP and HR before anesthesia（T₁）and 5（T₂）、10（T₃）、20（T₄）、30（T₅）、60（T₆）min after anesthesia,and after operation（T₇）,intraoperative and postoperative nausea and vomiting,as well as leukocytes and blood albumin contents at the day before surgery（D₀）,postoperative day 1（D₁）,postoperative day 3（D₃）,C-reactive protein（CPR）content at the day before surgery（D₀）,postoperative day 3（D₃）,at the same time serum interleukin 6（IL-6）,tumor necrosis factor-ɑ（TNF-ɑ）,malondialdehyde（MDA）contents were tested before fasting（T₀）,tourniquet release after 5 minutes（T₈）,6 hours（T₉）and 24 hours(T₁₀).Results 1.Compared with T₀,the levels of TNF-a、IL-6、MDA increased in different degrees after tourniquet release in the two groups,of which TNF-a visible increased in both groups at T₉、T₁₀(P_L9=0.013,P_S9=0.034,P_L10=0.002,P_S10=0.001),serum IL-6 in both groups increased significantly at T₈,T₉ and T₁₀(P_L8=0.023,P_L9=0.021,P_L10=0.008,P_S8=0.027,P_S9=0.043,P_S10=0.016),compare with each other,at T₈ and T₁₀,the expression of inflammatory cytokine IL-6 in group S was significantly lower than group L(P₈=0.008,P₁₀=0.048),and TNF-a、MDA were no significant difference between each other（P>0.05）.2.Compared with D₀,leukocytes and CRP increased and albumin decreased in the two groups after surgery,of which leukocytes increased significantly(P_L1<0.001,P_L3<0.001,P_S1<0.001,P_S3=0.007)and albumin decreased significantly（P<0.001）in both groups in D₁ and D₃,at the same time,CRP increased in two groups in D₃（P<0.001）,while there were no significant difference between the two groups（P>0.05）.3.The incidence of hunger sensation in group L（30%）was significantly higher than group S（0%）（P=0.021）.There were no significant difference between the two groups in general information,hemodynamics,the incidence rate of thirst,intraoperative and postoperative nausea and vomiting（P>0.05）.Conclusion 1.Preoperative oral carbohydrate can reduce the increase of systemic inflammatory mediator IL-6 which caused by the tourniquet ischemia-reperfusion injury in knee arthroplasty,and reduce the limb ischemia-reperfusion injury.2.Preoperative oral carbohydrate can significantly reduce patient’s hunger sensation,improve the level of comfort.