Purpose: To investigate the effects of different doses of rocuronium on ischemia-reperfusion injury in skeletal muscle induced by tourniquet in patients undergoing elective unilateral total knee arthroplasty.
Patients and Methods: A total of 90 patients undergoing elective unilateral knee arthroplasty under general anesthesia combined with femoral nerve block were randomly divided into 3 groups: normal saline group (group S), rocuronium 0.6 mg/kg group (group L), and rocuronium 1.2 mg/kg group (group H). The primary outcome was the expression of dystrophin in skeletal muscle at 60 min after ischemia. Secondary outcomes included the concentration of malondialdehyde (MDA) and neuronal nitric oxide synthase (nNOS) in blood at 5 min and 30 min after reperfusion. In addition, thigh girth at 24 h and 48 h after operation, the leaving bed time, the incidence of tourniquet-related hypertension and short-term (3 days after operation) complications (nausea and vomiting, swelling, blister, wound infection) and long-term (3 months after operation) complications (joint instability, stiffness, nerve paralysis, pain) were recorded.
Main Results: The expression of dystrophin in the rocuronium group was higher than that in group S after ischemia (P < 0.05). The concentration of MDA in the rocuronium 1.2 mg/kg group was lower at 30 min after reperfusion (P < 0.05). There was no significant difference in nNOS among groups at each time point (P > 0.05). The change of thigh girth was the smallest in the rocuronium 1.2 mg/kg group after operation (P< 0.05). The leaving bed time was significantly earlier after operation in the rocuronium group than that in group S (P < 0.05).
Conclusion: Rocuronium can protect skeletal muscle from ischemia-reperfusion injury induced by tourniquet. The mechanism may be related to the fact that rocuronium can reduce the loss of dystrophin in skeletal muscle and have the effects of anti-oxidation and anti-stress.
Trial Registration: The study was registered at http://www.chictr.org.cn (ChiCTR1800019221, registered on 2018– 10-31).

Keywords: ischemia-reperfusion injury, rocuronium, dystrophin, TKA


中文翻译：

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罗库溴铵对择期单侧全膝关节置换术患者止血带致骨骼肌缺血再灌注损伤的保护作用：一项前瞻性、双盲、随机、对照研究。

目的：探讨不同剂量罗库溴铵对择期单侧全膝关节置换术患者止血带致骨骼肌缺血再灌注损伤的影响。
患者和方法：将90例全麻联合股神经阻滞下择期单侧膝关节置换术患者随机分为3组：生理盐水组（S组）、罗库溴铵0.6mg/kg组（L组）、罗库溴铵1.2mg/kg组。组（H组）。主要结果是缺血后 60 分钟骨骼肌中肌营养不良蛋白的表达。次要结果包括再灌注后 5 分钟和 30 分钟血液中丙二醛 (MDA) 和神经元一氧化氮合酶 (nNOS) 的浓度。此外，术后 24 小时和 48 小时的大腿围、下床时间、止血带相关性高血压的发生率和短期（术后 3 天）并发症（恶心呕吐、肿胀、水疱、伤口感染）和长期（术后 3 个月）并发症（关节不稳定、
主要结果：缺血后罗库溴铵组dystrophin表达高于S组（P <0.05）。再灌注后30 ​​min，罗库溴铵1.2 mg/kg组MDA浓度降低（P <0.05）。各时间点各组间nNOS差异无统计学意义（P > 0.05）。罗库溴铵1.2 mg/kg组术后大腿围变化最小（P <0.05）。罗库溴铵组术后下床时间明显早于S组（P <0.05）。
结论：罗库溴铵可保护骨骼肌免受止血带引起的缺血再灌注损伤。其作用机制可能与罗库溴铵能减少骨骼肌肌营养不良蛋白的流失，具有抗氧化、抗应激的作用有关。
试验注册：该研究在http://www.chictr.org.cn注册（ChiCTR1800019221，注册时间：2018-10-31）。

关键词：缺血再灌注损伤，罗库溴铵，抗肌萎缩蛋白，TKA