摘要
目的:研究瑞芬太尼在成人体外循环心脏手术中通过调节NF-κB信号通路介导的炎症反应改善凝血功能的作用。方法:选取204例进行成人体外循环心脏手术治疗患者作为研究对象,按照干预方式不同将患者分成研究组与对照组。研究组患者采取瑞芬太尼目标控制输注麻醉;对照组患者采取舒芬太尼间断输注麻醉。比较两组患者的血流动力学指标、手术指标、炎性反应、应激反应、凝血功能、NF-κB信号通路及并发症发生情况。结果:两组患者不同时间点HR、MAP、CVP、CCI、SVV、PAP、SPO2及BIS的差异均有统计学意义(P<0.05),研究组体外循环时间、手术时间、舒芬太尼术后镇痛用量、丙泊酚使用量均低于对照组,主动脉阻断时间高于对照组(P<0.05)。手术后,两组炎性指标均升高,且研究组IL-6、TNF-α均低于对照组(P<0.05),IL-10高于对照组(P<0.05);两组氧化应激指标均显著升高,且研究组ACTH、Cor及C3a均低于对照组(P<0.05);研究组TT、APTT、PT均低于对照组(P<0.05);两组NF-κB信号通路指标均改善,且研究组P50、P65、Act1、IκBα均低于对照组(P<0.05);两组并发症总发生率无统计学差异(P>0.05)。结论:瑞芬太尼通过调节NF-κB信号通路,影响P65、P50、Act1和IκBα蛋白的表达,减少炎症因子释放,改善凝血功能,体现瑞芬太尼在镇痛方面的优势,且在术后免疫调节和凝血功能恢复中的重要作用。
Objective:To study the role of remifentanil in improving coagulation function by regulating the inflammatory response mediated by the NF-κB signaling pathway in adult cardiopulmonary bypass cardiac surgery.Methods:The research subjects were 204 adult patients who underwent cardiopulmonary bypass cardiac surgery.They were divided into two groups based on different intervention methods.The patients in the study group received targeted remifentanil infusion anesthesia,while those in the control group received intermittent sufentanil infusion anesthesia.The differences in hemodynamic indicators,surgical indicators,inflammatory response,stress response,coagulation function,NF-κB signaling pathway and complications were compared between the two groups.Results:The differences in HR,MAP,CVP,CCI,SVV,PAP,SPO 2 and BIS at different time points between the two groups were statistically significant(P<0.05).The cardiopulmonary bypass time,operation time,sufentanil dosage and propofol dosage in the study group were all lower than those in the control group,and the aortic cross-blocking time was higher than that in the control group(P<0.05).After the operation,The inflammatory indicators in both groups were significantly increased.The levels of IL-6 and TNF-αin the study group were lower than those in the control group(P<0.05),and IL-10 was higher than that in the control group(P<0.05).The oxidative stress indicators in both groups were significantly increased,and the levels of ACTH,Cor and C3a in the study group were lower than those in the control group(P<0.05).The coagulation functions of both groups fluctuated.Moreover,the TT,APTT and PT in the study group were all lower than those in the control group(P<0.05).The NF-κB signaling pathway indicators in both groups improved,and the P50,P65,Act1 and IκBαin the study group were all lower than those in the control group(P<0.05).There was no statistically significant difference in complications between the two groups(P>0.05).Conclusion:Remifentanil regulates the NF-κB signaling pathway,influencing the expression of P65,P50,Act1 and IκBαproteins,reducing the release of inflammatory factors,and improving coagulation function.This demonstrates the advantages of remifentanil in analgesia and its significant role in postoperative immune regulation and the recovery of coagulation function.
作者
刘晓宁
王岩英
王洋
赵成秀
王春阳
LIU Xiao-ning;WANG Yan-ying;WANG Yang;ZHAO Cheng-xiu;WANG Chun-yang(Department of Anesthesiology,Handan First Hospital,Handan 056002,Hebei,China;Operating Room,Handan First Hospital,Handan 056002,Hebei,China)
出处
《川北医学院学报》
2026年第1期77-82,共6页
Journal of North Sichuan Medical College
基金
河北省邯郸市科学技术研究与发展计划项目(23422083255)。
关键词
瑞芬太尼
NF-ΚB信号通路
体外循环
凝血功能
炎症反应
Remifentanil
NF-κB signaling pathway
Cardiopulmonary bypass
Coagulation function
Inflammatory response
