Effect Of Controlled Blood Reperfusion And The Shenmai Injection On The Myocardial Injury After Skeletal Muscle Ischemia Reperfusion

Objective:To assess the protective effect of controlled blood reperfusion and the Shenmai Injection against myocardial injury after skeletal muscle ischemia reperfusion.Methods:A total of 60 patients with total knee replacement surgery were choosen.They were randomly and equally divided into three groups.The control group(group A),controlled reperfusion group(group B)and controlled reperfusion with the Shenmai Injection group(group C).All the patients take a combined spinal-epidural anesthesia at the L2/3 interspace.Patients in group C were injected Shenmai Injection before tourniquet inflation,while patients in group A and group B received equal volume of normal saline instead.The one-stage deflation controlled by tourniquet deflation equipment was used in the group A.Then in group B and group C the tourniquet was slowly deflated.When the tourniquet pressure reduced 100mmHg,rest thirty seconds,Then slowly reduced the pressure of 100mmHg every thirty seconds,finally slowly and completely release the tourniquet.About 2ml arterial blood was taken just before using Shenmai Injection(T0),and 5min(T2),2h(T3)after tourniquet deflation As plasma samples for measuring the concentration of malondialdehyde(MDA),tumor necrosis factor-a(TNF-a)and heart-type fatty acid-binding protein(H-FABP).HR and MAP were recorded before tourniquet inflation(T0),and 1 min(T1),5min(T2)after tourniquet deflation.Results:There was no significant difference in sex,age,body mass index and the time of tourniquet inflation between the three groups(P>0.05).Compared with T0 point,HR of three groups increased at T1 point(P<0.05).HR at T2 point in group A were lower than that at T1 point(P<0.05).There was no significant difference between T2 point and T1 point in group B and group C(P>0.05).Three groups did not have significant difference on MAP at T0 point(P>0.05).Compared with T0 point,MAP of three groups decreased at T1 point(P<0.05).MAP at T2 point in group A were higher than that at T1 point(P<0.05).There was no significant difference between T2 point and T1 point in group B and group C(P>0.05).Compared with T0 point,MDA of three groups increased at T2 point and T3 point(P<0.05).The concentration of MDA at T3 point in group A was higher than that in group B and group C(P<0.05).Compared with T0 point,the concentration of TNF-a of three groups increased at T2 point and T3 point(P<0.05).The concentration of TNF-a at T3 point in group A was higher than that in group B and group C(P<0.05).Compared with T0 point,the concentration of H-FABP of three grops increased at T3 point(P<0.05).The concentration of H-FABP in group C was lower than that in group A and group B(P<0.05).Conclusions:A large number of oxygen free radicals was generated as ischemia-reperfusion injury then reacted with lipid to produce malondialdehyde(MDA).At the same time,inflammatory factors released and the concentration of tumor necrosis factor-?(TNF-?)increased.Myocardial injury happened after skeletal muscle ischemia reperfusion injury.Then the concentration of the heart-type fatty acid binding protein(H-FABP),which is specifically present in the myocardium,will be increased.The results of this study confirmed that controlled blood reperfusion can reduce hemodynamics fluctuations in patients,and decreased the concentration of MDA and TNF-a during skeletal muscle ischemia reperfusion.Shenmai injection has no effect of hemodynamics,but controlled blood reperfusion and the Shenmai Injection has protective effect on myocardial injury induced by ischemia reperfusion of skeletal muscle.