摘要
目的:观察瑞芬太尼联合丙泊酚麻醉与芬太尼联合丙泊酚麻醉在脑外科手术患者中的临床应用,分析患者手术前后血流动力学及血清白介素9(IL)-1β、IL-6和TNF-α的变化。方法:将收治的90例脑外科手术患者按照抽签法随机分为对照组(n=45)和观察组(n=45),其中对照组给予芬太尼联合丙泊酚麻醉,观察组给予瑞芬太尼联合丙泊酚麻醉,其他联合麻醉药物均相同,检测所有受试者气管插管前(T1)、气管插管后(T2)、切皮时(T3)和拔管时(T4)血流动力学及术前和术后24h血清IL-1β、IL-6和TNF-α。结果:T1时,两组脑外科手术患者血流动力学指标大小均无明显差异(P>0.05);T2、T3和T4时,观察组心率(HR)和平均动脉压(MAP)显著低于同期对照组,而血氧饱和度(SpO2)高于同期对照组,差异有统计学意义(P<0.05);T2、T3和T4时,对照组检测指标HR和MAP比T1时显著增高,而SpO2比T1时显著降低,差异有统计学意义(P<0.05),而观察组HR、MAP和SpO2与T1时比较,无明显差异(P>0.05)。术前,对照组和观察组血清IL-1β、IL-6、TNF-α指标大小无明显差异(P>0.05);术后24h,两组血清IL-1β、IL-6和TNF-α均高于术前(P<0.05);且术后24h,观察组血清IL-1β、IL-6和TNF-α均低于同期对照组,差异有显著性(P<0.05)。结论:瑞芬太尼联合丙泊酚麻醉能够维持患者血流动力学稳定,降低血清炎性因子浓度,是潜在有效麻醉复合剂之一。
Objective： To observe the clinical application of remifentanil combined with propofol anesthesia and fentanyl combined with propofol anesthesia in patients with brain surgery, and to analyze the hemodynamics and serum IL-1β, IL-6 and TNF-α before and after operation. Methods： A total of 90 patients with brain surgery were randomly divided into control group （n = 45） and observation group （n = 45）. All patients were given the same anesthesia combined with drugs. The control group was given fentanyl and the observation group was given remifentanil. Hemodynamics and inflammatory parameters were measured before and after surgery in all subjects. Results： There were no significant differences in the hemodynamic indexes between the two groups （P〉0.05）. At T2 , T3 and T4, the heart rate （HR） and mean arterial pressure （MAP） of the observation group were significantly lower than those of the control group, and the blood oxygen saturation （SpO2） was significantly higher than that of the control group （P〈0.05）. At T2, T3 and T4, the HR and MAP of the control group were significantly higher than those of T1 , while SpO2 was significantly lower than T1 （P〈0.05）. There was no significant difference in HR, MAP and SpOz between the observation group at T1 , T2 , Ta and T4 （P〈0.05）. There were no significant differences in serum IL-1β, IL-6 and TNF-α levels between the control group and the observation group before surgery （P〉0.05）. After 24 h of operation, the levels of IL-1β, IL-6 and TNF-α in the two groups were higher than those before operation （P〉0.05）. The levels of IL-1β, IL-6 and TNF-α in the observation group were significantly lower than those in the control group at 24 h after the operation （P 〈0.05）. Conclusion： Remifentanil combined with propofol anesthesia can maintain the hemodynamic stability and reduce the concentration of inflammatory factors, which is one of the potential effective anesthetic compounds.
出处
《海南医学院学报》
CAS
2017年第15期2078-2081,共4页
Journal of Hainan Medical University
基金
武汉市科技引导计划(20161232988-02)
