摘要
目的：探讨Narcotrend指导下全身麻醉对老年腹部手术患者术后应激反应及炎性细胞因子的影响。方法：选取2015年1月-2015年12月本院住院行腹部手术的普外科老年患者150例作为本研究的研究对象并随机分为3组,分别采取不同的麻醉深度,检测麻醉前、术后1 h、术后1 d应激反应指标：COR、ACTH、CRP、ET-1,炎性因子：IL-6、TNF-α浓度并进行比较。结果：本研究发现D0组、D2组、E2组3组患者Cor、ACTH、CRP、ET-1差异均有统计学意义（P〈0.05）;各个时间点的Cor、ACTH、CRP差异也有统计学意义（P〈0.05）,D0组、D2组Cor在术后1 h、术后1 d均显著升高（均P〈0.05）,D0组、D2组、E2组ACTH在术后1 h、术后1 d均显著升高（均P〈0.05）,D0组CRP在术后1 h、术后1 d均显著升高（均P〈0.05）;D0组、D2组不同时间点Cor升高幅度大于E2组（P〈0.05）,D2组不同时间点ACTH升高幅度小于D0组、E2组（P〈0.05）,D0组不同时间点CRP在升高幅度大于D2组、E2组（P〈0.05）,D0组、D2组不同时间点ET-1变化不大,E2组不同时间点ET-1降低幅度均显著大于D0组、D2组（P〈0.05）。D0组、D2组、E2组三组患者IL-6、TNF-α差异均有统计学意义（P〈0.05）;各个时间点的IL-6、TNF-α差异也有统计学意义（P〈0.05）,D0组IL-6、TNF-α在术后1 h、术后1 d均显著升高（P〈0.05）;D0组不同时间点IL-6、TNF-α升高幅度大于D2组、E2组（P〈0.05）。结论：在Narcotrend指导下,不同麻醉深度的全身麻醉对老年腹部手术患者术后的应激反应及炎性细胞因子的影响不同,以D2为最优,可以有效抑制机体的应激反应及炎性细胞因子的影响。
Objective： To investigate the effect of general anesthesia on stress response and inflammatory cytokines in elderly patients undergoing abdominal surgery under the guidance of Narcotrend. Methods： A total of 150 elderly patients with abdominal surgery in our hospital from January 2015 to December 2015 were randomly divided into three groups： D0,D2 and E2 group,each 50 cases. With different depth of anesthesia,the stress response indexes COR,ACTH,CRP and ET-1,the inflammatory factors IL-6 andTNF-α before anesthesia,postoperative 1 h and postoperative 1 d were compared. Results： The differences of Cor,ACTH,CRP and ET-1 in the three groups D0,D2 and E2 were all statistically significant（ P〈0. 05）; the differences of Cor,ACTH and CRP at each time point were also statistically significant（ P〈0. 05）,Cor in D0 and D2 group were significantly increased postoperative 1 h and 1d（ P〈0. 05）,ACTH in D0,D2 and E2 group were significantly increased postoperative 1 h and 1 d（ P〈0. 05）,CRP in D0 group was significantly increased postoperative 1 h and 1 d（ P〈0. 05）; The increase amplitude of Cor in D0 and D2 group at each time point was higher than in E2 group（ P〈0. 05）,the increase amplitude of ACTH in D2 group at each time point was lower than in D0 and E2group（ P〈0. 05）,the increase amplitude of CRP in D0 group at each time point was higher than in D2 and E2 group（ P〈0. 05）,ET-1 in D0 and D2 group had no changes at each time point,while the decrease amplitude of ET-1 in E2 group at each time point was significantly higher than in D0 and D2 group（ P〈0. 05）. The differences of IL-6 and TNF-α in the three groups D0,D2 and E2 were all statistically significant（ P〈0. 05）; the differences of IL-6 and TNF-α at each time point were also statistically significant（ P〈0.05）,IL-6 and TNF-α in D0 group were significantly increased postoperative 1 h and 1 d（ P〈0. 05）; the increase amplitude of IL-6and TNF-α in D0 group at each time point was higher than in D2 and E2 group（ P〈0. 05）. Conclusions： Under the guidance of Narcotrend,different depth of anesthesia has different degree of stress response and depth of anesthesia in elderly patients with abdominal surgery,D2 is the best,it could effectively inhibit the body＇s stress response and the influence of inflammatory cytokines.
出处
《海南医学院学报》
CAS
2016年第18期2213-2216,共4页
Journal of Hainan Medical University
基金
四川省卫计委课题(0305030250)~~
