丙泊酚复合瑞芬太尼对老年高血压腹部手术患者氧代谢及S100β BDNF Aβ-42/tau的影响
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摘要
目的:探讨丙泊酚复合瑞芬太尼对老年高血压腹部手术患者氧代谢及S100β、BDNF、Aβ-42/tau的影响。方法:选取2017年1月至2018年5月期间在全麻气管插管下行腹部手术的老年高血压患者80例,采用数字随机法将其分为对照组、观察组,每组40例。对照组采用丙泊酚麻醉维持;观察组采用丙泊酚复合瑞芬太尼麻醉维持。比较两组在手术过程中不同时间点血压及心率变化情况;并记录术中艾司洛尔和硝酸甘油用量,呼吸恢复时间,苏醒时间,拔气管导管时间,对比其脑氧代谢指标、血清S100β、脑源性神经营养因子(BDNF)、Aβ-42、tau-181水平、苏醒后不良反应发生率。结果:对照组与观察组在拔管时(T3)收缩压、舒张压及心率值较术前(T1)、手术完毕时(T2)、拔管后10min(T4)明显升高,且差异均具有统计学意义(P<0.05)。对照组患者呼吸恢复时间、苏醒时间及拔气管导管时间均晚于观察组,艾司洛尔及硝酸甘油用量则均高于观察组,且差异具有统计学意义(t=10.300,P=0.000;t=13.172,P=0.000;t=9.077,P=0.000;t=6.314,P=0.000;t=11.744,P=0.000)。T1时两组CERO_2、Da-jvO_2无差异(t=0.482,P=0.631);开始手术(T5)、开始手术后0.5h(T6)、T2时观察组CERO_2、Da-jvO_2小于对照组(t=3.445,P=0.001,t=4.551,P=0.000,t=3.894,P=0.000;t=3.571,P=0.001,t=5.489,P=0.000,t=4.112,P=0.000)。T1时两组血清S100β、BDNF、Aβ-42、tau-181无差异(t=0.735,P=0.465;t=0.588,P=0.558;t=0.262,P=0.794;t=0.261,P=0.795);T5、T2、手术后1d(T7)时观察组血清S100β、Aβ-42、tau-181小于对照组,BDNF大于对照组(t=6.914,P=0.000,t=11.524,P=0.000,t=6.600,P=0.000;t=3.267,P=0.002,t=4.746,P=0.000,t=3.665,P=0.000;t=5.941,P=0.000,t=6.521,P=0.000,t=4.406,P=0.000;t=2.919,P=0.005,t=4.282,P=0.000,t=4.047,P=0.000)。两组苏醒后嗜睡、血压异常、心率失常、恶心呕吐发生率不具有统计学意义(χ~2=0.346,P=0.556;χ~2=0.000,P=1.000;χ~2=1.013,P=0.314;χ~2=0.346,P=0.556)。结论:丙泊酚复合瑞芬太尼应用于老年高血压患者麻醉,术中患者血压及心率稳定,有效的减少降压药的用量,对脑氧代谢和脑神经细胞的影响小,术后苏醒迅速,有利于缩短患者手术室停留时间。
Objective: To study the effects of propofol and remifentanil on oxygen metabolism and S100 β, BDNF,Aβ-42/tau in elderly patients with hypertension undergoing abdominal surgery. Methods: 80 elderly hypertensive patients undergoing general anesthesia tracheal intubation and abdominal surgery were selected from January 2017 to May 2018. They were randomly divided into control group and observation group, with 40 cases in each group. The control group was maintained with propofol anesthesia; the observation group was anesthetized with propofol and remifentanil. The sphygmomanometer heart rate changes at different time points during the operation were compared between the two groups. The intraoperative esmolol and nitroglycerin levels, respiration recovery time, resuscitation time, catheter removal time, and incidence of adverse reactions after resuscitation were recorded. And the levels of cerebral oxygen metabolism, serum S100 β, brain-derived neurotrophic factor(BDNF), Aβ-42, and tau-181 were compared. Results: The systolic blood pressure, diastolic blood pressure and heart rate of the control group and the observation group at the time of extubation(T3) were significantly higher than before(T1), after the completion of surgery(T2), and after the extubation(T4), and the differences were statistically significant. Significance(P<0.05). Respiratory recovery time, resuscitation time and organ extraction time of the control group were all later than those of the observation group, and the use of esmolol and nitroglycerin were both higher than the observation group, and the difference was statistically significant(t=10.300,P=0.000; t=13.172,P=0.000;t=9.077, P=0.000; t=6.314, P=0.000; t=11.744, P=0.000). There was no difference in CERO_2 and Da-jvO_2 in the two groups at T1(P>0.05), and the indexes in the observation group were lower than those in the control group at the beginning of operation(T5), 0.5 h after operation(T6) and T2(t=3.445, P=0.001, t=4.551, P=0.000, t=3.894, P=0.000; t=3.571, P=0.001, t=5.489, P=0.000, t=4.112, P=0.000). There was no difference in serum S100 β, BDNF, A β-42 and tau-181 between the two groups at T1(t=0.735, P=0.465; t=0.588, P=0.558; t=0.262, P=0.794; t=0.261, P=0.795). The serum levels of S100 β, A β-42 and tau-181 in the observation group were lower than those in the control group, while the levels of serum BDNF in the observation group were higher than the control group(t=6.914, P=0.000, t=11.524, P=0.000, t=6.600, P=0.000; t=3.267, P=0.002, t=4.746, P=0.000, t=3.665, P=0.000; t=5.941, P=0.000, t=6.521, P=0.000, t=4.406, P=0.000; t=2.919, P=0.005, t=4.282, P=0.000, t=4.047, P=0.000). The incidence of lethargy, abnormal blood pressure, abnormal heart rate, nausea and vomiting were not statistically significant in the two groups(χ~2=0.346, P=0.556; χ~2=0.000, P=1.000; χ~2=1.013, P=0.314; χ~2=0.346, P=0.556). Conclusion: The blood pressure and heart rate were stable during the operation by propofol combined with remifentanil, and the amount of antihypertensive drugs was effectively reduced. It has little effect on cerebral oxygen metabolism and brain nerve cells. The postoperative recovery was rapid and it was helpful to shorten the operating room residence time.
Objective: To study the effects of propofol and remifentanil on oxygen metabolism and S100 β, BDNF,Aβ-42/tau in elderly patients with hypertension undergoing abdominal surgery. Methods: 80 elderly hypertensive patients undergoing general anesthesia tracheal intubation and abdominal surgery were selected from January 2017 to May 2018. They were randomly divided into control group and observation group, with 40 cases in each group. The control group was maintained with propofol anesthesia; the observation group was anesthetized with propofol and remifentanil. The sphygmomanometer heart rate changes at different time points during the operation were compared between the two groups. The intraoperative esmolol and nitroglycerin levels, respiration recovery time, resuscitation time, catheter removal time, and incidence of adverse reactions after resuscitation were recorded. And the levels of cerebral oxygen metabolism, serum S100 β, brain-derived neurotrophic factor(BDNF), Aβ-42, and tau-181 were compared. Results: The systolic blood pressure, diastolic blood pressure and heart rate of the control group and the observation group at the time of extubation(T3) were significantly higher than before(T1), after the completion of surgery(T2), and after the extubation(T4), and the differences were statistically significant. Significance(P<0.05). Respiratory recovery time, resuscitation time and organ extraction time of the control group were all later than those of the observation group, and the use of esmolol and nitroglycerin were both higher than the observation group, and the difference was statistically significant(t=10.300,P=0.000; t=13.172,P=0.000;t=9.077, P=0.000; t=6.314, P=0.000; t=11.744, P=0.000). There was no difference in CERO_2 and Da-jvO_2 in the two groups at T1(P>0.05), and the indexes in the observation group were lower than those in the control group at the beginning of operation(T5), 0.5 h after operation(T6) and T2(t=3.445, P=0.001, t=4.551, P=0.000, t=3.894, P=0.000; t=3.571, P=0.001, t=5.489, P=0.000, t=4.112, P=0.000). There was no difference in serum S100 β, BDNF, A β-42 and tau-181 between the two groups at T1(t=0.735, P=0.465; t=0.588, P=0.558; t=0.262, P=0.794; t=0.261, P=0.795). The serum levels of S100 β, A β-42 and tau-181 in the observation group were lower than those in the control group, while the levels of serum BDNF in the observation group were higher than the control group(t=6.914, P=0.000, t=11.524, P=0.000, t=6.600, P=0.000; t=3.267, P=0.002, t=4.746, P=0.000, t=3.665, P=0.000; t=5.941, P=0.000, t=6.521, P=0.000, t=4.406, P=0.000; t=2.919, P=0.005, t=4.282, P=0.000, t=4.047, P=0.000). The incidence of lethargy, abnormal blood pressure, abnormal heart rate, nausea and vomiting were not statistically significant in the two groups(χ~2=0.346, P=0.556; χ~2=0.000, P=1.000; χ~2=1.013, P=0.314; χ~2=0.346, P=0.556). Conclusion: The blood pressure and heart rate were stable during the operation by propofol combined with remifentanil, and the amount of antihypertensive drugs was effectively reduced. It has little effect on cerebral oxygen metabolism and brain nerve cells. The postoperative recovery was rapid and it was helpful to shorten the operating room residence time.
引文
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[7] 刘华,罗芬,吕东森,等.中青年患者择期手术静脉复合全麻中不同剂量瑞芬太尼、丙泊酚维持的量效关系[J].现代中西医结合杂志,2014,23(7):693～695.
[8] 徐霞,胡礼宏,方向明.急性高容量血液稀释对腹腔镜前列腺癌根治术患者脑氧代谢的影响[J].中国输血杂志,2018,31(4):387～390.
[9] 罗彦弟,杨迟达,胡杨.血清BDNF与MG对原发性高血压患者认知功能水平的影响[J].中国现代医学杂志,2018,28(9):76～80.
[2] Chidambaran V,Costandi A,D'Mello A.Propofol:a review of its role in pediatric anesthesia and sedation.[J].CNS Drugs,2015,29(7):543～563.
[3] 郭海燕,李淑虹,李琳章,等.右美托咪定对脑膜瘤切除术患者血清S100β蛋白及神经元特异性烯醇化酶的影响[J].中国临床药理学与治疗学,2016,21(5):562～566.
[4] Chung JY,Chang WY,Lin TW,et al.An analysis of surgical outcomes in patients aged 80 years and older.[J].Acta Anaesthesiol Taiwan,2014,52(4):153～158.
[5] Zettervall SL,Sirajuddin S,Akst S,et al.Use of propofol as an induction agent in the acutely injured patient.[J].Eur Trauma Emerg Surg,2015,41(4):405～411.
[6] Cardesin A,Pontes C,Rosell R,et al.A randomised double blind clinical trial to compare surgical field bleeding during endoscopic sinus surgery with clonidine-based or remifentanil-based hypotensive anaesthesia.[J].Rhinology,2015 ,53(2):107～115.
[7] 刘华,罗芬,吕东森,等.中青年患者择期手术静脉复合全麻中不同剂量瑞芬太尼、丙泊酚维持的量效关系[J].现代中西医结合杂志,2014,23(7):693～695.
[8] 徐霞,胡礼宏,方向明.急性高容量血液稀释对腹腔镜前列腺癌根治术患者脑氧代谢的影响[J].中国输血杂志,2018,31(4):387～390.
[9] 罗彦弟,杨迟达,胡杨.血清BDNF与MG对原发性高血压患者认知功能水平的影响[J].中国现代医学杂志,2018,28(9):76～80.