两种麻醉深度对腹部手术患者脑氧代谢及致痛物质的影响  

Effects of two anesthetic depths on cerebral oxygen metabolism and pain-causing substances in patients undergoing abdominal surgery

作　　者：卫晓娜[1] 李海霞[1] 杨晓彬[1] 陈永学[1] WEI Xiao-na;LI Hai-xia;YANG Xiao-bin(Department of Anesthesiology,Handan Central Hospital,Handan Hebei 056002,China)

机构地区：[1]邯郸市中心医院麻醉科,河北邯郸056002

出　　处：《临床和实验医学杂志》2023年第20期2225-2230,共6页Journal of Clinical and Experimental Medicine

基　　金：河北省医学科学研究课题计划(编号:20191862)。

摘　　要：目的观察两种麻醉深度对腹部手术患者脑氧代谢及致痛物质的影响。方法回顾性选取2019年6月至2021年6月邯郸市中心医院收治的全凭静脉麻醉下行腹部手术的患者150例进行研究,依据麻醉深度不同分为浅麻醉组和深麻醉组,各75例。术中以脑电双频指数(BIS)检测麻醉深度,浅麻醉组BIS维持在50~59,深麻醉组BIS维持在30~39。统计两组手术时间、麻醉时间、苏醒时间、拔管时间、出血量。观察两组麻醉诱导前(T_(0))、插管前(T_(1))、插管后(T_(2))、手术前(T_(3))、手术后(T_(4))、拔管时(T_(5))的平均动脉压(MAP)和心率,测定两组T_(0)、T_(1)、T_(2)、T_(3)、T_(4)、T_(5)脑氧代谢指标[脑动脉-静脉血氧含量差(Da-jvO_(2))、脑氧摄取率(CERO_(2))],测定两组T_(0)、术后12 h(T_(6))、24 h(T_(7))、48 h(T_(8))血清致痛物质[5-羟色胺(5-HT)、P物质、肾上腺素(E)],测定两组术前、术后3 d、术后7 d的炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)],统计两组不良反应发生情况。结果两组手术时间、麻醉时间、拔管时间、出血量比较,差异均无统计学意义(P>0.05);深麻醉组的苏醒时间显著多于浅麻醉组,差异有统计学意义(P<0.05)。术中不同时点两组MAP、心率比较,差异均无统计学意义(P>0.05)。T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时,深麻醉组Da-jvO_(2)、CERO_(2)均显著低于浅麻醉组,差异均有统计学意义(P<0.05)。T_(6)、T_(7)、T_(8)时,深麻醉组5-HT、P物质、E水平均显著低于浅麻醉组,差异均有统计学意义(P<0.05)。术前、术后3 d、术后7 d,两组IL-6、TNF-α水平比较,差异均无统计学意义(P>0.05)。深麻醉组不良反应发生率显著低于浅麻醉组,差异有统计学意义(P<0.05)。结论深度麻醉(BIS维持在30~39)下行腹部手术会抑制脑氧代谢,并抑制术后血清致痛物质5-HT、P物质、E水平,减轻痛觉信息传递,有利于降低不良反应发生率。Objective To observe the effects of two anesthesia depths on cerebral oxygen metabolism and pain-causing substances in patients undergoing abdominal surgery.Methods A retrospective study was conducted on 150 patients undergoing abdominal surgery under total intravenous anesthesia admitted to Handan Central Hospital from June 2019 to June 2021.They were divided into shallow anesthesia group and deep anesthesia group based on different anesthesia depths,with 75 patients in each group.The depth of anesthesia was measured by bispectral index(BIS).The BIS in shallow anesthesia group was maintained at 50-59 and that in deep anesthesia group was maintained at 30-39.The operation time,anesthesia time,recovery time,extubation time and bleeding volume of the two groups were counted.The mean arterial pressure(MAP)and heart rate before anesthesia induction(T_(0)),before intubation(T_(1)),after intubation(T_(2)),before operation(T_(3)),after operation(T_(4)),and at extubation(T_(5))were observed,the cerebral oxygen metabolism indexes of T_(0),T_(1),T_(2),T_(3),T_(4)and T_(5)[cerebral arterial venous oxygen content difference(Da-jvO_(2))and cerebral oxygen uptake rate(CERO_(2))]were measured,Serum pain causing substances[serotonin(5-HT),serum substance P and adrenaline(E)]were measured at T_(0),12 h(T_(6)),24 h(T_(7))and 48 h(T_(8))after operation,the inflammatory factors[interleukin-6(IL-6),Tumor necrosis factor-α(TNF-α)]were measured before operation,3 days and 7 days after operation,and the incidence of adverse reactions in the two groups was counted.Results There was no statistically significant difference in surgical time,anesthesia time,extubation time,and bleeding volume between the two groups(P>0.05).The awakening time of the deep anesthesia group was significantly longer than that of the shallow anesthesia group,the difference was statistically significant(P<0.05).There was no statistically significant difference in MAP and HR between the two groups at different time points(P>0.05).Da-jvO_(2),CERO_(2)in deep anesthe

关 键 词：脑电双频指数 麻醉深度 腹部手术 脑氧代谢 致痛物质 

分 类 号：R614[医药卫生—麻醉学]