氢吗啡酮对妇科腹腔镜手术患者围术期细胞因子的影响  

Effect of hydromorphone on peri-operative cytokines in laparoscopic surgery patients

作　　者：敖青华[1] 夏东云[1] 舒敬华[1] 冯娟[1] 邱国美[1] 周慧芳 

机构地区：[1]绍兴市妇幼保健院麻醉科,浙江绍兴312000 [2]浙江省人民医院产科,浙江杭州310014

出　　处：《中华全科医学》2016年第12期2054-2056,2152,共4页Chinese Journal of General Practice

基　　金：2014浙江省医药卫生科技计划项目(2014KYB033)

摘　　要：目的探讨氢吗啡酮对妇科腹腔镜手术患者围术期应激因子和炎性因子水平的影响。方法选择2015年1—12月绍兴市妇幼保健院全麻下行妇科腹腔镜手术患者100例作为研究对象,随机将其分为氢吗啡酮组和芬太尼组,每组各50例。ELISA法测定血清皮质醇、去甲肾上腺素、肾上腺素、C反应蛋白、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)和白细胞介素-6(IL-6)水平。结果与入室5 min比较,2组患者插管时平均动脉压和心率升高(P<0.05),芬太尼组拔管后10 min平均动脉压和心率降低(P<0.05);和芬太尼组比较,氢吗啡酮组拔管后10 min平均动脉压和心率升高(P<0.05)。与入室5 min比较,2组插管时甲肾上腺素、肾上腺素水平升高(P<0.05),皮质醇水平降低(P<0.05),拔管后10 min芬太尼组去甲肾上腺素水平升高(P<0.05);与芬太尼组比较,氢吗啡酮组插管时去甲肾上腺素和肾上腺素水平降低(P<0.05),皮质醇水平升高(P<0.05)。与入室5 min比较,2组手术30 min、手术结束、术后1 h的TNF-α和IL-6水平升高(P<0.05),2组手术结束和术后1 h的IL-10水平升高(P<0.05);与芬太尼组比较,氢吗啡酮组手术30 min、手术结束、术后1 h的TNF-α和IL-6水平降低(P<0.05),手术结束和术后1 h的IL-10水平升高(P<0.05)。结论氢吗啡酮用于全麻妇科腹腔镜手术,围手术期血流动力学较稳定,可减轻围手术期应激反应和炎症反应。Objective To explore the effect of hydromorphone on perioperative stress factors and inflammatory cytokines in laparoscopic surgery patients. Methods Selected 100 cases of anesthesia laparoscopic surgery patients from January, 2015 to December,2015 in Shaoxing City maternal and child health hospital as research subjects, and were divided into hydromorphone group and fentanyl group. ELISA assay detected serum cortisol, norepinephrine, epinephrine, C-reactive protein, tumor necrosis faetor-α （ TNF-α ）, intedeukin-10 （ IL-10 ） and interleukin-6 （ IL-6 ） levels. Results Compared with burglary 5 min,the mean arterial pressure and heart rate when patients were intubated in two groups increased（ P 〈 O. 05 ）, the mean arterial pressure and heart rate at 10min after extubation of fentanyl group decreased（ P 〈 0. 05 ）. Compared with fentanyl group, the mean arterial pressure and heart rate of hydromorphone group at 10 min after extubation increased（ P 〈 0.05 ）. Compared with burglary 5 min, the norepinephrine, epinephrine levels at intubation in two groups in- creased（ P 〈 0. 05 ） ,cortisol levels decreased （P 〈 0.05 ） ,the norepinephrine levels at 10 min after extubation of fentanyl group increased（ P 〈 0. 05 ） ;compared with fentanyl group, the norepinephrine and epinephrine levels of hydromorphone group at intubation decreased （ P 〈 0.05 ）, cortisol levels increased （ P 〈 0. 05 ）. Compared with burglary 5 min, the TNF-ot and IL-6 levels in two groups at surgical 30 min, the end of surgery, postoperative 1 h increased（ P 〈 0.05 ） , the IL-10 levels of two groups after the end of surgery and postoperative 1 h increased （ P 〈 0. 05 ） ; compared with fentanyl group, the TNF-α and IL-6 levels of hydromorphone group at surgical 30 min, the end of surgery, postoperative lh decreased（ P 〈 0. 05 ） , and the IL-10 levels increased at the end of surgery, postoperative 1 h （ P 〈 0. 05 ）. Conclusion Hydromorphone used in anesthesia for laparoscopi

关 键 词：盐酸氢吗啡酮 氧化性应激 妇科腹腔镜 炎症 

分 类 号：R971.2[医药卫生—药品] R713[医药卫生—药学]