纳布啡对单肺通气手术患者围术期神经认知障碍的影响  

Effects of nalbuphine on perioperative neurocognitive disorders in patients undergoing one-lung ventilation surgery

作　　者：秦怀峰[1] 陈海涛[1] 刘绍正 吴会生[2] 郭培培 QIN Huai-feng;CHEN Hai-tao;LIU Shao-zheng;WU Hui-sheng;GUO Pei-pei(Department of Anesthesiology,Wanbei Coal-electricity Group General Hospital/The Third Affiliated Hospital of Bengbu Medical College,Suzhou ANHUI 234000,China;Department of Anesthesiology,Zhongnan Hospital,Wuhan University,Wuhan HUBEI 430071,China)

机构地区：[1]皖北煤电集团总医院/蚌埠医学院第三附属医院麻醉科,安徽宿州234000 [2]武汉大学中南医院麻醉科,湖北武汉430071

出　　处：《中国新药与临床杂志》2020年第5期286-290,共5页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的观察纳布啡对单肺通气下胸腔镜手术患者围术期神经认知障碍(PND)的影响,并探讨其可能机制。方法将60例拟在单肺通气下行胸腔镜手术患者随机分为纳布啡组和对照组,每组30例。纳布啡组于麻醉诱导前10 min静脉注射纳布啡0.3 mg·kg-1,对照组在对应时刻给予等容积氯化钠注射液。2组患者均采用全身麻醉,麻醉诱导与维持方式均一致。术中监测局部脑氧饱和度(rSO2)及患者生命体征。于术前1日(T0)、手术开始后30 min(T1)、术毕即刻(T2)、术后第3日(T3)和术后第7日(T4)检测血清炎性细胞因子和脂联素(ADP)水平,并于T0、T3、T4使用相关认知量表评估患者神经认知功能。结果纳布啡组术中rSO2平均值高于对照组(P <0.05),rSO2较基础值下降的最大百分数低于对照组(P <0.05)。与T0时比较,2组T3、T4时简易精神状态检查量表(MMSE)评分均降低(P <0.05),但同时点纳布啡组MMSE评分高于对照组(P <0.05)。T3、T4时纳布啡PND发生率均低于对照组(P <0.05)。与T0时比较,纳布啡组T1~T3时、对照组T1~T4时血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-10水平均升高(P <0.05),而同时点ADP水平均降低(P <0.05)。T2~T4时纳布啡组血清TNF-α、IL-6、IL-10水平低于同时点对照组(P <0.05),ADP水平高于同时点对照组(P <0.05)。结论纳布啡可一定程度降低单肺通气患者PND发生率,提高ADP、rSO2水平,其机制可能与抑制围术期炎症反应有关。AIM To observe the effects of nalbuphine on perioperative neurocognitive disorders(PND of patients undergoing thoracoscopic surgery under one-lung ventilation, and to explore its possible mechanism. METHODS Sixty patients undergoing thoracoscopic surgery under one-lung ventilation were randomly and doubleblindly divided into two groups(n = 30 each): nalbuphine treatment group(group N) and control group(group C). In the group N, nalbuphine 0.3 mg·kg-1 was injected intravenously 10 minutes before induction of anesthesia. In the group C, equal volume of sodium chloride injection was given at the corresponding time. General anesthesia was used in both groups, and anesthesia induction and maintenance were the same. Regional cerebral oxygen saturation(rSO2) and basic vital signs were continuously monitored during the operation. Inflammatory mediators(TNF-α, IL-6, IL-10) and serum adiponectin(ADP) were measured one day before operation(T0), 30 minutes after operation(T1), immediately after operation(T2), three days after operation(T3) and seven days after operation(T4). The neurocognitive function of the patients in the two groups was tested with the relevant cognitive scale at T0, T3 and T4. RESULTS Compared with the group C, the mean rSO2 during the operation increased in the group N, while the rSO2%max decreased significantly(P < 0.05). Compared with T0, the scores of Mini-Mental State Examination(MMSE) at T3 and T4 were lower in the two groups(P < 0.05). Compared with the group C, the scores of MMSE increased at some time points, while the incidence of PND decreased significantly(P < 0.05). Compared with T0, the serum levels of TNF-α, IL-6 and IL-10 in the group N at T1-T3 and the group C at T1-T4 increased significantly(P < 0.05), while the levels of ADP were decreased at the same time point(P < 0.05). Compared with the group C, the serum levels of TNF-α, IL-6 and IL-10 in the group N decreased significantly at T2-T4(P < 0.05), but the levels of ADP were higher(P < 0.05). CONCLUSION Nalbuphine can reduce the le

关 键 词：纳布啡 单肺通气 认知 炎症 脑氧饱和度 

分 类 号：R971[医药卫生—药品]