瑞芬太尼联合丙泊酚静脉靶控麻醉对脑外科手术患者炎症反应、氧化应激及神经递质的影响  

Effects of remifentanil combined with propofol intravenous target controlled anesthesia on inflammatory reaction,oxidative stress and neurotransmitter in patients undergoing surgery in cerebral surgery

作　　者：毛延坤 杭博 曾渊 MAO Yan-kun;HANG Bo;ZENG Yuan(Department of Anesthesiology,Xi'an No.3 Hospital,Xi'an 710018,Shaanxi,China;Department of Anesthesiology,Ordnance Industry 521 Hospital,Xi'an 710065,Shaanxi,China)

机构地区：[1]西安市第三医院麻醉科,陕西西安710018 [2]西安市兵器工业521医院麻醉科,陕西西安710065

出　　处：《海南医学院学报》2018年第23期2050-2053,共4页Journal of Hainan Medical University

基　　金：陕西省科技计划基金资助项目(2017SF163)~~

摘　　要：目的:探讨瑞芬太尼联合丙泊酚静脉靶控麻醉对脑外科手术患者炎症反应、氧化应激及神经递质的影响。方法:86例脑外科手术患者依据抽签法分为对照组(n=43)和研究组(n=43),对照组患者采用芬太尼联合丙泊酚静脉靶控麻醉方案,研究组患者给予瑞芬太尼联合丙泊酚静脉靶控麻醉方案,比较麻醉诱导前(T0),气管插管时(T1)及拔管时(T2)三个时刻患者炎症因子、氧化应激及神经递质水平。结果:两组间T0时刻超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、丙二醛(MDA)、超氧化物歧化酶(SOD)、血清去甲肾上腺素(NE)、醛固酮(ALD)及血浆肾素活性(PRA)水平比较差异不显著(P>0.05);与同组内T0时刻相比,两组T1、T2时刻hs-CRP、TNF-α、MDA、NE、ALD及PRA水平均不同程度的升高,SOD水平降低(P均<0.05)。研究组T1、T2时刻hs-CRP、TNF-α水平[(13.18±2.29)mg/L、(70.92±18.97)ng/L,(15.53±4.78)mg/L和(89.15±29.56)ng/L]均较同时刻对照组水平显著降低(P<0.05)。研究组T1、T2时刻MDA水平分别为(3.69±0.42)、(4.74±0.51)mmol/L,均显著低于同时刻对照组;SOD水平为(67.66±9.50)、(63.21±5.64)U/mL,均显著高于同时刻对照组(均<0.05)。研究组T1、T2时刻NE、ALD及PRA水平[(310.29±20.38)、(314.62±19.61)ng/mL,(220.89±15.21)、(233.62±15.85)pg/mL,(4.75±1.28)、(4.87±1.32)ng/mL/24h],均显著低于同时刻对照组(P均<0.05)。结论:瑞舒芬太尼联合丙泊酚静脉靶控麻醉可有效减轻脑外科手术患者的炎症反应,改善氧化应激状态,对神经递质指标影响较小,具有重要临床价值。Objective:To investigate the effect of remifentanil combined with propofol intravenous target controlled anesthesia on inflammatory reaction,oxidative stress and neurotransmitter in patients undergoing cerebral surgery surgery.Methods:A total of 86 cases of cerebral surgery patients were divided into control group(n=43)and study group(n=43)based on random lottery method,the patients in the control group were given fentanyl combined with propofol intravenous target controlled anesthesia,and the study group patients were given remifentanil and propofol intravenous target controlled anesthesia,the levels of inflammatory factors,oxidative stress and neurotransmitter levels of the two groups were compared before anesthesia induction(T0),tracheal intubation(T1)and extubation(T2)at three time points.Results:No statistical difference of the levels of hs-CRP,TNF-α,MDA,SOD,NE,ALD and PRA between the two groups at T0 moment(P>0.05).Compared with the levels of T0 moment in the same group,hs-CRP,TNF-α,MDA,NE,ALD and PRA levels in the two groups of T1 and T2 increased at different degrees,and the level of SOD decreased(P<0.05).The levels of hs-CRP and TNF-αat the time of T1 and T2 in the study group were(13.18±2.29)mg/L,(70.92±18.97)ng/L,(15.53±4.78)mg/L and(89.15±29.56)ng/L,respectively,which were significantly lower than those of the control group at the same time(all P<0.05).The MDA levels at the T1 and T2 levels of the study group were(3.69±0.42)mmol/L and(4.74±0.51)mmol/L,respectively,which were significantly lower than those of the control group at the same time(all P<0.05).The SOD level were(67.66±9.50)U/mL and(63.21±5.64)U/mL,respectively,which were significantly higher than those of the control group at the same time(all P<0.05).The NE,ALD and PRA levels at the T1 and T2 levels of the study group were(310.29±20.38)ng/mL and(314.62±19.61)ng/mL,(220.89±15.21)pg/mL and(233.62±15.85)pg/mL and(4.75±1.28)ng/mL/24h and(4.87±1.32)ng/mL/24 h,respectively,which were significantly lower than the control group at

关 键 词：瑞芬太尼 丙泊酚 脑外科手术 炎症反应 氧化应激 神经递质 

分 类 号：R614[医药卫生—麻醉学]