七氟烷联合舒芬太尼对创伤性失血休克患者血清相关细胞凋亡因子的影响  

Effect of sufentanil combined with sevoflurane on serum apoptosis-related factors of traumatic hemorrhagic shock patients

作　　者：卢孙山 易斌[1] 鲁开智[1] 杨勇[1] 杨智勇[1] 

机构地区：[1]第三军医大学西南医院麻醉科,重庆400038

出　　处：《第三军医大学学报》2016年第8期868-873,共6页Journal of Third Military Medical University

摘　　要：目的观察七氟烷联合舒芬太尼对创伤性失血休克患者组织细胞凋亡和炎症反应的影响。方法选取2011年5月至2013年11月在我院全身麻醉下进行急诊手术的120例创伤性失血休克患者为研究对象,将其分为4组:对照组(A组)、七氟烷组(B组)、舒芬太尼组(C组)和0.1μg/kg舒芬太尼+1.0%七氟烷组(D组)。每组30例,分别于药物处理前(T0)、药物处理后15 min(T1)、30 min(T2)、2 h(T3)和24 h(T4)抽取静脉血,测定患者血清中肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、超氧化物歧化酶(superoxide dismutase,SOD)、白介素-6(interleukin-6,IL-6)、重组人细胞间粘附因子-1(intercellular cell adhesion molecule-1,ICAM-1)以及半胱氨酸天冬氨酸特异性蛋白酶-3(cysteine aspartic acid specific protease-3,Caspase-3)的表达水平。结果给药前,组间各项指标差异均无统计学意义(P>0.05)。与A组比较,七氟烷用药后2 h,能够抑制创伤性失血休克患者细胞TNF-α、Caspase-3的表达,促进SOD的表达;联合使用七氟烷和舒芬太尼进行麻醉治疗,可有效增加上述表达效果。与B、C组比较,D组患者IL-6和ICAM-1的表达水平明显低于A组(P<0.05)。给药后,4组患者平均动脉压和中心静脉压均显著降低(P<0.05);而各组患者心率降低的幅度差异无统计学意义(P>0.05)。B、C、D组患者手术中自主呼吸恢复时间、苏醒时间以及输液量均显著低于A组(P<0.05),D组患者输液量显著低于B、C组(P<0.05)。D组出现ARDS和MODS并发症的人数显著低于其余3组(P<0.05),而4组中出现DIC的患者人数相近,差异无统计学意义(P>0.05)。另外,4种用药方式对患者术后肝肾功能的损伤均较轻微,差异无统计学意义(P>0.05)。结论七氟烷联合舒芬太尼能够有效抑制创伤性失血休克患者组织细胞凋亡,减轻炎性反应,具有保护其脏器组织的作用。Objective To observe the changes of apoptosis-related factors and inflammatory responses in the patients with traumatic hemorrhagic shock after treatment with sevoflurane and sufentanil. Methods A total of 120 patients receiving hemorrhagic shock trauma emergency surgery under general anesthesia were selected from May 2011 to November 2013 in our hospital for the study. They were randomly divided into group A（ control group）,group B（ sevoflurane group）,group C（ sufentanil group） and group D（ 0. 1 μg /kg sufentanil and 1. 0% sevoflurane group）. There were 30 patients in each group. Venous blood of the patients was sampled before drug treatment（ T0） and after drug treatment of 15 min（ T1）,30 min（ T2）,2h（ T3） and 24 h（ T4）. The expression levels of serum tumor necrosis factor-α（ TNF-α）,cysteine aspartic acid specific protease-3（ Caspase-3）,superoxide dismutase（ SOD）,interleukin-6（ IL-6） and intercellular cell adhesion molecule-1（ ICAM-1） were determined. Results There were no significant differences in the indicators between the four groups before drug administration（ P〉0. 05）. Compared with group A,after sevoflurane administration for 2 h,the expressions of Caspase-3 and TNF-α in traumatic hemorrhagic shock patients were inhibited,but the expression of SOD was promoted. The combination of sevoflurane and sufentanil for anesthesia therapy may effectively enhance the above expressions. Compared with group A,the expressions of IL-6 and ICAM-1 were significantly lower in group B,group C and group D（ P〈0. 05）. After drug treatment,the mean arterial pressure and central venous pressure of all the patients were significantly decreased（ P〈0. 05）,but the descending trend of heart rates in each group had no significant difference.The spontaneous breathing recovery time,recovery time,and transfusion amount of group B,group C and group D were significantly lower than those of group A（ P〈0. 05）,and the transfusion amount in group D was significa

关 键 词：创伤性失血休克 七氟烷 舒芬太尼 TNF-α CASPASE-3 IL-6 

分 类 号：R392.3[医药卫生—免疫学] R605.971[医药卫生—基础医学]