The effect of etomidate on the oxidative stress response and levels of inflammatory factors resulting from ischemia-reperfusion injury of the lower extremities during tibial fracture surgery were investigated. From December 2013 to June 2015, 60 tibial fracture patients with surgical indications for open reduction and internal fixation were selected. Patients were randomly divided into the observation group and the control group. All patients were stanched by tourniquet hemostasis. Patients in the observation group were anesthetized with etomidate (3–6 mg/kg·h) + remifentanil (0.1–0.25 µg/kg/min) administered with an injection pump to maintain intraoperative sedation and analgesia anesthesia. Patients in the control group received propofol (3–6 mg/kg·h) + remifentanil (0.1–0.25 µg/kg/min). Before surgery (T0), before surgery was completed and anesthesia was stopped (T1), 24 h after surgery (T3), 48 h after surgery (T4), and 1 week after surgery (T5), serum superoxide dismutase (SOD) activity was determined with a kit, and ELISA was used to measure the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1, and IL-6 in peripheral blood from both groups of patients. Surgery in both groups was completed smoothly. We found that serum SOD levels of patients in the observation group were significantly higher than those of the control group, while the levels of TNF-α, IL-1, and IL-6 released by neutrophils were significantly decreased after ischemia-reperfusion injury (P<0.05). Postoperative length of stay in hospital of the observation group was significantly shorter and the occurrence rate of anesthesia complications was significantly lower than in the control group (P<0.05). In conclusion, during surgery for lower limb fracture, the use of etomidate for maintaining sedation can effectively maintain serum SOD activity and inhibit the release of inflammatory factors after ischemia-reperfusion injury of the fracture, to reduce the occurrence rate of anesthesia complications after surgery.
The clinching process is more and more used in automotive design and manufacturing. Traditional quality inspection of joints needs a lot of destructive tests, which is time-consuming and material-consuming. In this paper, the clinching process and joints failure of dissimilar materials, 6061 aluminium alloy and HC340/590DP dual-phase steel, are studied. A two-dimensional finite element model is established. Experiments were carried out to verify the numerical model. Through the axial tensile test, the quality of clinched joints for upper steel-lower aluminium alloy and upper aluminium alloy-lower steel were measured, respectively, and the strength and safety of the joints met the requirements of design indexes. The conventional prediction model of maximum tensile force and its modified model was researched. Combined with numerical simulation results, the fracture load, the separation load, and the failure mode of two clinched joints were predicted, respectively. Furthermore, the results are in good agreement with the experimental results. The results show that the modified prediction model of maximum tensile force has a good prediction result, and the error rate is less than 10%. The modified prediction model of maximum tensile force can effectively predict the tensile failure test results, which provides a basis for the quality evaluation and strength prediction optimization of dissimilar materials clinched joints.
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