摘要
目的探讨不同麻醉深度对胸腔镜下肺叶切除患者应激状态及炎症介质的影响。方法选取行胸腔镜下肺叶切除治疗的肺癌患者89例为研究对象。根据术中脑电双频谱指数(BIS)区间,将患者分为深麻醉组(40~<50,n=45)和浅麻醉组(50~<60,n=44)。比较2组患者不同时点(麻醉诱导前、插管即刻、病灶切除前、术毕)的生命体征(平均动脉压、心率、血氧饱和度)、麻醉苏醒时间、拔管时间、血管活性药物用量、术后疼痛程度[视觉模拟评分法(VAS)]、术后镇痛药物用量和围术期应激状态[前列腺素E2(PGE2)、神经生长因子(NGF)、P物质(SP)]、炎症介质[神经元特异性烯醇化酶(NSE)、肿瘤坏死因子-α(TNF-α)、S100β蛋白]水平以及麻醉相关不良反应发生情况。结果病灶切除前、术毕,深麻醉组的平均动脉压、心率低于浅麻醉组,差异有统计学意义(P<0.05)。深麻醉组的麻醉苏醒时间、拔管时间长于浅麻醉组,差异有统计学意义(P<0.05)。术毕、术后1 d,深麻醉组的PGE2、NGF、SP水平低于浅麻醉组,NSE、TNF-α、S100β蛋白水平高于浅麻醉组,差异有统计学意义(P<0.05)。2组血管活性药物用量、VAS评分、舒芬太尼用量以及麻醉相关不良反应发生率比较,差异无统计学意义(P>0.05)。结论胸腔镜下肺叶切除患者单肺通气时,深麻醉状态可有效控制手术应激,维持术中血流动力学稳定,但术后清醒延迟、炎症反应明显;浅麻醉状态术后清醒快、炎症介质水平低,但术中应激反应明显、血流动力学不稳定。
Objective To investigate the effects of different anesthesia depths on stress states and inflammatory mediators in patients undergoing video-assisted thoracoscopic lobectomy.Methods A total of 89 lung cancer patients who underwent video-assisted thoracoscopic lobectomy were selected as study subjects.Based on intraoperative bispectral index(BIS)range,the patients were divided into deep anesthesia group(BIS of 40 to<50,n=45)and shallow anesthesia group(BIS of 50 to<60,n=44).Vital signs(mean arterial pressure,heart rate and blood oxygen saturation),anesthesia recovery time,extubation time,dosage of vasoactive drugs,postoperative pain intensity[Visual Analogue Scale(VAS)],postoperative analgesic dosage,perioperative stress state[prostaglandin E2(PGE2),nerve growth factor(NGF)and substance P(SP)],levels of inflammatory mediators[neuron-specific enolase(NSE),tumor necrosis factor-α(TNF-α)and S100β protein]at different time points(before anesthesia induction,immediately after intubation,before lesion resection and at the end of surgery)and the incidence of anesthesia-related adverse reactions were compared between the two groups.Results Before lesion resection and at the end of surgery,the mean arterial pressure and heart rate in the deep anesthesia group were significantly lower than those in the shallow anesthesia group(P<0.05).The anesthesia recovery time and extubation time in the deep anesthesia group were significantly longer than those in the shallow anesthesia group(P<0.05).At the end of surgery and on postoperative day one,the levels of PGE2,NGF and SP in the deep anesthesia group were significantly lower than those in the shallow anesthesia group,while the levels f NSE,TNF-α and S100β protein were significantly higher than those in the shallow anesthesia group(P<0.05).There were no significant differences in the dosage of vasoactive drugs,VAS scores,sufentanil dosage and the incidence of anesthesia-related adverse reactions between thetwo groups(P>0.05).Conclusion During one-lung ventilation in patients undergoing video-assisted thoracoscopic surgery lobectomy,deep anesthesia can effectively control surgical stress and maintain stability of intraoperative hemodynamics,but it is associated with delayed postoperative awakening and more pronounced inflammatory response.Shallow anesthesia results in faster postoperative awakening and lower levels of inflammatory mediators,but it is associated with more significant intraoperative stress response and unstable hemodynamics.
作者
展瑞静
柴颖
宋杰
盛晨
田佳
马俊杰
ZHAN Ruijing;CHAI Ying;SONG Jie;SHENG Chen;TIAN Jia;MA Junjie(the Second People's Hospital of Liaocheng in Shandong Province,Liaocheng,Shandong,252600)
出处
《实用临床医药杂志》
2025年第14期61-67,共7页
Journal of Clinical Medicine in Practice
基金
山东省医药卫生科技发展计划项目(2019WS105)。
关键词
单肺通气
麻醉
胸腔镜
肺叶切除术
肺癌
氧化应激
炎症介质
脑电双频谱指数
one-lung ventilation
anesthesia
thoracoscopy
lobectomy
lung cancer
oxidative stress
inflammatory mediator
bispectral index
