Abstract
Reperfusion after tourniquet use can induce inflammation and cause remote organ injury. We evaluated the therapeutic effect of transcutaneous electrical acupoint stimulation (TEAS) on inflammatory mediators and lung function in patients receiving lower limb tourniquets. Forty patients undergoing unilateral lower extremity surgery with tourniquet were randomly assigned to two groups: the TEAS group and ischemia-reperfusion (I/R) group. The C-C motif chemokine ligand 2 (CCL2), C-X-C motif chemokine ligand 8 (CXCL8), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), and arterial blood gas analysis were measured preoperatively and 6 h after tourniquet removal. The levels of CXCL8, IL-1, IL-6, TNF-α, and CCL2 were significantly increased compared to baseline values in both groups, but the increase was significantly smaller in the TEAS group. In the TEAS group, the partial pressure of oxygen and arterial-alveolar oxygen tension ratio were significantly decreased, and the alveolar-arterial oxygen tension difference and respiratory index were significantly increased, compared to those in the I/R group at 6 h after reperfusion. In conclusion, TEAS diminished the upregulation of proinflammatory factors in response to lower limb ischemia-reperfusion and improved pulmonary gas exchange.
Highlights
Lower limb ischemia can be caused by a variety of clinical conditions, including critical limb ischemia, abdominal aortic aneurysm, and traumatic arterial injury [1]
Our previous research showed that tourniquet-induced lung injury was correlated with impaired gas exchange and that inflammation factors such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) are important mediators of this effect [10]
We demonstrated that limb ischemiareperfusion can lead to (1) a systemic inflammatory response, represented by an increase of proinflammatory factors like IL-6 and C motif chemokine ligand 2 (CCL2), and (2) impaired gas exchange in the lungs, demonstrated by decreased PaO2, A-aO2, and respiratory index (RI)
Summary
Lower limb ischemia can be caused by a variety of clinical conditions, including critical limb ischemia, abdominal aortic aneurysm, and traumatic arterial injury [1]. Tourniquets are typically used in orthopedic surgery to reduce intraoperative blood loss and decrease the allogeneic blood transfusion rate, providing clear vision for the surgery This condition may be much more important in orthopedic procedures in which tourniquetrelated ischemia-reperfusion damage develops and the lung gets injured [9]. Our previous research showed that tourniquet-induced lung injury was correlated with impaired gas exchange and that inflammation factors such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) are important mediators of this effect [10]. This suggests that reducing the inflammatory response should have a positive effect on postoperative recovery. The inflammatory factors are released as a result of the impairment of endothelial function and neutrophil infiltration during deflation of the tourniquet [8]
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