不同镇静深度对重度动脉瘤性蛛网膜下腔出血患者脑脊液细胞因子水平的影响  

Effect of different sedation depth on cytokine levels in cerebrospinal fluid of patients with severe aneurysmal subarachnoid hemorrhage

作　　者：张皓 豆欣蔓 ZHANG Hao;DOU Xinman(School of Nursing,Lanzhou University,Lanzhou 730010,China;Lanzhou University Second Hospital,Lanzhou 730030,China)

机构地区：[1]兰州大学护理学院,甘肃兰州730010 [2]兰州大学第二医院,甘肃兰州730030

出　　处：《中国实用神经疾病杂志》2023年第8期997-1001,共5页Chinese Journal of Practical Nervous Diseases

基　　金：萃英科技创新计划-应用基础研究-面上项目(编号:CY2020-MS19)。

摘　　要：目的探讨不同镇静深度对重度动脉瘤性蛛网膜下腔出血患者脑脊液白介素-4(IL-4)、白介素-6(IL-6)、白介素-8(IL-8)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平的影响。方法选择2022-04-2023-03入住兰州大学第二医院神经重症科的动脉瘤性蛛网膜下腔出血患者作为研究对象。所有患者根据Hunt-Hess分级分为4组,即A组(Ⅰ级18例)、B组(Ⅱ级15例)、C组(Ⅲ级16例)、D组(Ⅳ~Ⅴ级38例)。发病后48 h内行血管瘤栓塞术,术后第1天行腰穿术留取脑脊液检测细胞因子,与Hunt-Hess分级行Spearman相关性分析。D组患者随后分为浅镇静组与深镇静组,分别于术后第1、3、5天留取脑脊液检测细胞因子,比较二者之间的差异。结果术后第1天,随着Hunt-Hess分级的增加,4组间IL-4、IL-6、IL-8、IL-10、TNF-α水平比较,脑脊液IL-6[Ⅰ级(164±13)ng/L,Ⅱ级(353±36)ng/L,Ⅲ级(531±38)ng/L,Ⅳ~Ⅴ级(712±51)ng/L]、IL-8[Ⅰ级(223±21)ng/L,Ⅱ级(303±27)ng/L,Ⅲ级(507±32)ng/L,Ⅳ~Ⅴ级(834±61)ng/L]、IL-10[Ⅰ级(8.19±0.41)ng/L,Ⅱ级(12.83±3.07)ng/L,Ⅲ级(20.59±2.30)ng/L,Ⅳ~Ⅴ级(23.86±3.75)ng/L]、TNF-α[Ⅰ级(0.52±0.03)ng/L,Ⅱ级(0.61±0.02)ng/L,Ⅲ级(0.81±0.07)ng/L,Ⅳ~Ⅴ级(0.93±0.06)ng/L]水平均明显增加,差异有统计学意义(P<0.05),而IL-4[Ⅰ级(2.32±0.32)ng/L,Ⅱ级(2.36±0.35)ng/L,Ⅲ级(2.41±0.25)ng/L,Ⅳ~Ⅴ级(2.34±0.30)ng/L]差异无统计学意义(P>0.05);Hunt-Hess分级与IL-4、IL-6、IL-8、IL-10、TNF-α水平的Spearman相关分析,相关系数分别为0.945、0.947、0.867、0.916,具有相关性(P<0.05)。深镇静组IL-6、IL-8、IL-10、TNF-α水平较浅镇静组在术后第1天差异无统计学意义(P>0.05)。深镇静组与浅镇静组第1、3、5天IL-6、IL-8、IL-10、TNF-α水平比较,深镇静组上述四种炎症因子第3、5天分别为(842±43)ng/L、(578±28)ng/L、(8.99±0.4)ng/L、(1.07±0.16)ng/L和(679±29)ng/L、(428±39)ng/L、(6.56±0.6)ng/L、(0.78±0.08)ng/L;浅镇静组上述四种炎�Objective To investigate the effect of different sedation depth on the levels of interleukin-4(IL-4),interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α)in cerebrospinal fluid(CSF)of patients with severe aneurysmal subarachnoid hemorrhage(aSAH).Methods Patients with aneurysmal subarachnoid hemorrhage admitted to the Department of Neurocritical Care of the Second Hospital of Lanzhou University from April 2022 to march 2023 were selected as the study subjects.All patients were divided into 4 groups according to Hunt-Hess classification:group A(gradeⅠ,n=18),group B(gradeⅡ,n=15),group C(gradeⅢ,n=16)and group D(gradeⅣ-Ⅴ,n=38).Embolization of hemangioma was performed within 48 hours after the onset of the disease,and cerebrospinal fluid was collected by lumbar puncture on the first day after the operation to detect cytokines.Spearman correlation analysis was performed with Hunt-Hess classification.The patients in group D were divided into light sedation group and deep sedation group.The CSF was collected on the 1st,3rd and 5th day after operation respectively to detect the cytokines.Result On the first day after operation,with the increase of Hunt-Hess grading,the level of IL-6[gradeⅠ(164±13)ng/L,gradeⅡ(353±36)ng/L,gradeⅢ(531±38)ng/L,gradeⅣ-Ⅴ(712±51)ng/L],IL-8[gradeⅠ(223±21)ng/L,gradeⅡ(303±27)ng/L,gradeⅢ(507±32)ng/L,gradeⅣ-Ⅴ(834±61)ng/L],IL-10[gradeⅠ(8.19±0.41)ng/L,gradeⅡ(12.83±3.07)ng/L,gradeⅢ(20.59±2.30)ng/L,gradeⅣ-Ⅴ(23.86±3.75)ng/L]and TNF-α[gradeⅠ(0.52±0.03)ng/L,gradeⅡ(0.61±0.02)ng/L,gradeⅢ(0.81±0.07)ng/L,gradeⅣ-Ⅴ(0.93±0.06)ng/L]were significantly increased,the difference between each other had statistical significance(P<0.05),while the level of IL-4[gradeⅠ(2.32±0.32)ng/L,gradeⅡ(2.36±0.35)ng/L,gradeⅢ(2.41±0.25)ng/L,gradeⅣ-Ⅴ(2.34±0.30)ng/L]between the four groups had no statistical significance(P>0.05).Spearman correlation analysis was performed between Hunt-Hess classification and the levels

关 键 词：深镇静 浅镇静 动脉瘤 蛛网膜下腔出血 脑脊液 细胞因子 

分 类 号：R743.35[医药卫生—神经病学与精神病学]