瑞芬太尼合七氟烷吸入对腹腔镜子宫切除术患者炎症应激反应、疼痛介质和血清NSE、S100β蛋白水平的影响  

Effects of Remifentanil Combined with Sevoflurane Inhalation on Inflammatory Stress Response,Pain Mediators,Serum NSE and S100β Protein in Patients Undergoing Laparoscopic Hysterectomy

作　　者：何园园 桂新星 肖金辉[1] 刘荣[1] 倪建毛[2] HE Yuan-yuan;GUI Xin-xing;XIAO Jin-hui;LIU Rong;NI Jian-mao(Department of Anesthesiology,The 908 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Yingtan,Jiangxi,335000,China;Department of Critical Medicine,The 908 Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army,Yingtan,Jiangxi,335000,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇八医院麻醉科,江西鹰潭335000 [2]中国人民解放军联勤保障部队第九〇八医院重症医学科,江西鹰潭335000

出　　处：《现代生物医学进展》2022年第13期2499-2503,共5页Progress in Modern Biomedicine

基　　金：江西省卫生计生委科技计划项目(20165304)。

摘　　要：目的:探讨瑞芬太尼联合七氟烷吸入对腹腔镜子宫切除术患者炎症应激反应、疼痛介质和血清神经元特异性烯醇化酶(NSE)、S100β蛋白水平的影响。方法:经随机数字表法,将2020年3月~2021年8月期间来我院接受腹腔镜子宫切除术的105例患者分为对照组(n=52)和研究组(n=53),对照组患者接受瑞芬太尼诱导,研究组在瑞芬太尼诱导基础上联合七氟烷吸入。对比两组血流动力学、炎症应激反应、疼痛介质和血清NSE、S100β蛋白,对比视觉模拟评分法(VAS)、简易精神状态量表(MMSE)评分变化,记录两组围术期间不良反应发生情况。结果:两组麻醉诱导前5 min(T1)、插管后5 min(T2)、手术完成时(T3)时点心率(HR)、平均动脉压(MAP)升高后降低,但T2、T3时点研究组低于对照组(P<0.05)。两组T1、T2、T3时点血氧饱和度(SpO_(2))无明显变化(P>0.05)。术后1 d,两组血清皮质醇(Cor)、去甲肾上腺素(NE)、白介素-1β(IL-1β)、白介素-6(IL-6)水平升高,但研究组低于对照组(P<0.05)。术后1 d,两组血清P物质(SP)、前列腺素E2(PGE2)水平升高,但研究组低于对照组(P<0.05)。术后1 d,两组血清NSE、S100β蛋白水平升高,但研究组低于对照组(P<0.05)。研究组术后1 d VAS评分低于对照组,术后3 d MMSE评分高于对照组(P<0.05)。两组不良反应发生率对比无差异(P>0.05)。结论:瑞芬太尼联合七氟烷吸入应用于腹腔镜子宫切除术患者,可稳定血流动力学,减轻炎症及应激反应,同时还可减轻术后疼痛,减轻认知功能损害。Objective:To investigate the effects of remifentanil combined with sevoflurane inhalation on inflammatory stress response,pain mediators,serum neuron specific enolase(NSE) and S100β protein in patients undergoing laparoscopic hysterectomy.Methods:105 patients who underwent laparoscopic hysterectomy in our hospital from March 2020 to August 2021 were randomly divided into control group(n=52) and study group(n=53) according to the random number table method.The patients in the control group were induced by remifentanil,and the study group was combined with sevoflurane inhalation on the basis of remifentanil induction.Hemodynamics,inflammation and stress response,pain mediators,serum NSE and S100β were compared between the two groups.The changes of visual analogue scale(VAS) and mini mental state scale(MMSE) were compared to record the occurrence of adverse reactions during perioperative period.Results:The heart rate(HR) and mean arterial pressure(MAP) in the two groups increased and decreased at 5 minutes before anesthesia induction(T1),5 minutes after intubation(T2) and at the time of operation completion(T3),but the time points of T2 and T3 in the study group were lower than those in the control group(P0.05).1 d after operation,serum Cortisol(Cor),norepinephrine(NE),interleukin-1β(IL-1β),Interleukin-6(IL-6) increased,but it was lower in the study group than that in the control group(P0.05).Conclusion:Remifentanil combined with sevoflurane inhalation in patients undergoing laparoscopic hysterectomy can stabilize hemodynamics,reduce inflammation and stress response,reduce postoperative pain and cognitive impairment.

关 键 词：瑞芬太尼 七氟烷 腹腔镜子宫切除术 炎症应激反应 疼痛介质 神经元特异性烯醇化酶 S100Β蛋白 

分 类 号：R713.4[医药卫生—妇产科学]