白眉蛇毒血凝酶联合右美托咪定对鼻内镜手术围术期患者鼻部黏膜水通道蛋白水平及生活质量的影响  

Effects of Hemopertase from Snake Venom Combined with Dexmedetomidine on Levels of Nasal Mucosal Aquaporin and Quality of Life in Patients Undergoing Nasal Endoscopic Surgery During Perioperative Period

作　　者：庾燕君[1] 于霖[1] 吴新俊 朱海威 YU Yanjun;YU Lin;WU Xinjun;ZHU Haiwei(Dept. of Anesthesiology, Dongguan People’s Hospital, Guangdong Dongguan 523000, China;Dept. of Pain, Donghua Hospital of Dongguan, Guangdong Dongguan 523000, China;Dept. of Surgery, Children’s Hospital of Dongguan, Guangdong Dongguan 523000, China)

机构地区：[1]东莞市人民医院麻醉科,广东东莞523000 [2]东莞市东华医院疼痛科,广东东莞523000 [3]东莞市儿童医院外科,广东东莞523000

出　　处：《中国医院用药评价与分析》2020年第4期438-441,445,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：东莞市社会科技发展(一般)项目(No.201750715001288)。

摘　　要：目的:探讨白眉蛇毒血凝酶联合右美托咪定对鼻内镜手术围术期患者鼻部黏膜水通道蛋白(AQP-1)水平及生活质量的影响。方法:将2017年5月至2018年5月东莞市儿童医院、东莞市东华医院及东莞市人民医院收治的择期在全身麻醉下行功能性鼻内镜手术患者620例,采用随机数字表法分为联合组和对照组,每组310例。对照组患者在术前15 min给予右美托咪定0.5μg/kg静脉注射,以0.4μg/(kg·h)持续静脉泵注;联合组患者采用右美托咪定与白眉蛇毒血凝酶联合应用,术前15 min给予右美托咪定0.5μg/kg静脉注射,以0.4μg/(kg·h)持续静脉泵注,配合术前30 min白眉蛇毒血凝酶2 KU肌内注射。于术前、术后即刻、术后1 d及术后3 d时记录两组患者血清白细胞介素6(IL-6)、白细胞介素10(IL-10)水平,于术前和术后2、4周及8周时记录两组患者的AQP-1水平和生活质量,观察两组患者的出血量、手术时间、拔管时间、自主呼吸恢复时间及不良反应、并发症发生情况。结果:术后即刻、术后1 d和术后3 d,联合组患者血清IL-6、IL-10水平明显低于对照组,差异均有统计学意义(P<0.05)。术后2、4和8周,联合组患者健康调查简表评分明显高于对照组,鼻腔鼻窦结局测试-20评分明显低于对照组;术后4、8周,联合组患者黏膜AQP-1水平明显低于对照组,上述差异均有统计学意义(P<0.05)。联合组患者出血量明显低于对照组,手术时间明显短于对照组,差异均有统计学意义(P<0.05);两组患者拔管时间、自主呼吸恢复时间的差异均无统计学意义(P>0.05)。两组患者均未发生呼吸抑制、躁动等严重并发症;对照组患者发生口干3例;观察组患者发生口干2例,心动过缓1例。结论:白眉蛇毒血凝酶联合右美托咪定可降低鼻内镜手术围术期患者鼻部黏膜AQP-1水平和炎症因子的表达,提高生活质量,且并发症少,对临床有一定借鉴意义。OBJECTIVE:To probe into the effects of hemopertase from snake venom combined with dexmedetomidine on levels of nasal mucosal aquaporin(AQP-1)and quality of life in patients undergoing nasal endoscopic surgery during perioperative period.METHODS:Totally 620 patients undergoing nasal endoscopic surgery under elective general anesthesia admitted into Children’s Hospital of Dongguan,Donghua Hospital of Dongguan and Dongguan People’s Hospital from May 2017 to May 2018 were extracted to be divided into the combination group and the control group via the random number table,with 310 cases in each group.Patients in the control group were given dexmedetomidine 0.5 g/kg intravenously at 15 min before surgery,followed by continuous intravenous pumping at 0.4 g/(kg·h).And the combination group was treated with dexmedetomidine combined with hematothrombin,0.5μg/kg dexmedetomidine was given in intravenous infusion at 15 min before surgery,followed by continuous intravenous pumping at 0.4 g/(kg·h)and intramuscular injection of hematothrombin 2 KU at 30 min before surgery.Levels of serum interleukin 6(IL-6)and interleukin 10(IL-10)of two groups were recorded before surgery,immediately after surgery,after surgery of 1 d and after surgery of 3 d.AQP-1 level and quality of life of two groups were observed before surgery and after surgery of 2,4 and 8 weeks.Bleeding volume,surgery time,extubation time,spontaneous breathing recovery time,and incidence of of adverse drug reactions and complications of two groups were compared.RESULTS:Immediately after surgery,after surgery of 1 d and after surgery of 3 d,the levels of serum IL-6 and IL-10 in the combination group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).After surgery of 2,4 and 8 weeks,the score of Health Survey Questionnaire of the combination group was significantly higher than that of the control group,and sino-nasal outcome test-20(SNOT-20)was significantly lower than that of the control group;after

关 键 词：白眉蛇毒血凝酶 右美托咪定 鼻内镜手术 鼻部黏膜水通道蛋白 生活质量 

分 类 号：R973.1[医药卫生—药品] R971[医药卫生—药学]