罗哌卡因复合地佐辛对颅脑手术患者围术期氧化应激反应及血浆细胞因子的影响
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摘要
目的:探讨罗哌卡因复合地佐辛对颅脑手术患者围术期氧化应激反应及血浆细胞因子的影响。方法:选择行颅脑手术的80例患者作为研究对象,按随机数字表法分为对照组和观察组,每组40例。对照组采用地佐辛进行麻醉,观察组给予罗哌卡因复合地佐辛麻醉。比较两组患者麻醉效果、不良反应发生率以及麻醉诱导前(T0)、术后1 h(T1)、术后6 h(T2)、术后24 h(T3)的血糖(Glu)、血浆皮质醇(Cor)、丙二醛(MDA)、一氧化氮(NO)、血浆肿瘤坏死因子(TNF-α)和可溶性细胞间黏附分子-1(sICAM-1)水平。结果:观察组镇痛效果持续时间显著长于对照组,气管拔管时间和麻醉恢复时间显著短于对照组(均P<0.05);麻醉后,与T0比较,两组T1、T2、T3时点时点血浆Glu、Cor、NO、MDA、TNF-α和sICAM-1水平升高,且同一时点观察组各指标均低于对照组,差异均具有统计学意义(均P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:罗哌卡因复合地佐辛对颅脑手术患者麻醉效果满意,可降低围术期氧化应激和炎症反应,具有较好的颅脑保护作用,且安全性好。
Objective:To investigate the effect of ropivacaine and dezocine on perioperative oxidative stress and plasma cytokines in patients undergoing cerebral surgery.Methods:A total of 80 patients who underwent cerebral surgery were randomly divided into a control group and an observation group,with 40 cases in each group.The patients in the control group were anesthetized with dezocine,and those in the observation group were anesthetized with ropivacaine and dezocine.The anesthetic effects and the incidence of adverse reactions as well as the levels of blood glucose(Glu),plasma cortisol(Cor),malondialdehyde(MDA),nitric oxide(NO),tumor necrosis factor(TNF)-α and soluble intercellular adhesion molecule(sICAM)-1 before the induction of anesthesia(T0),and 1 h(T1),6 h(T2),24 h(T3) after surgery were compared.Results:The duration of analgesia in the observation group was significantly higher than that in the control group,while the extubation time and anesthesia recovery time were significantly lower(P<0.05).After treatment,the levels of Glu,Cor,NO,MDA,TNF-α and sICAM-1 in the observation group were significantly higher than those in the control group at the same time point(P<0.05).No significant difference in the incidence of adverse reactions was noted between the two groups(P>0.05).Conclusion:The anesthetic effect of ropivacaine combined with dezocine for cerebral surgery was satisfactory.This combination could reduce perioperative oxidative stress and inflammatory reaction,and was safe.
Objective:To investigate the effect of ropivacaine and dezocine on perioperative oxidative stress and plasma cytokines in patients undergoing cerebral surgery.Methods:A total of 80 patients who underwent cerebral surgery were randomly divided into a control group and an observation group,with 40 cases in each group.The patients in the control group were anesthetized with dezocine,and those in the observation group were anesthetized with ropivacaine and dezocine.The anesthetic effects and the incidence of adverse reactions as well as the levels of blood glucose(Glu),plasma cortisol(Cor),malondialdehyde(MDA),nitric oxide(NO),tumor necrosis factor(TNF)-α and soluble intercellular adhesion molecule(sICAM)-1 before the induction of anesthesia(T0),and 1 h(T1),6 h(T2),24 h(T3) after surgery were compared.Results:The duration of analgesia in the observation group was significantly higher than that in the control group,while the extubation time and anesthesia recovery time were significantly lower(P<0.05).After treatment,the levels of Glu,Cor,NO,MDA,TNF-α and sICAM-1 in the observation group were significantly higher than those in the control group at the same time point(P<0.05).No significant difference in the incidence of adverse reactions was noted between the two groups(P>0.05).Conclusion:The anesthetic effect of ropivacaine combined with dezocine for cerebral surgery was satisfactory.This combination could reduce perioperative oxidative stress and inflammatory reaction,and was safe.
引文
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[11] 邵明璐,李洋,崔华峰,等.针刺预处理对大鼠心肌缺血再灌注氧化应激损伤的保护作用[J].中国针灸,2017,37(3):285-290.
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[13] 贾献辉,叶常红.罗哌卡因与地佐辛联合使用对颅脑外科 ASA Ⅰ,Ⅱ 级患者全麻恢复期躁动的影响[J].中国生化药物杂志,2016,36(1):89-91.
[14] 陶立德,薛同敏,张杰,等.缺血预处理对大鼠缺血再灌注肝组织 NF-κB 表达,炎症及氧化应激反应的影响[J].中国普通外科杂志,2015,24(1):70-73.
[15] 谭志勇.急性脑卒中患者血清炎症细胞因子水平变化及临床意义[J].西南国防医药,2016,26(10):1107-1110.
[16] 郭丹,陶晓三,邓捩根.罗哌卡因和地佐辛超前镇痛对手术后血浆IL-1的影响[J].南昌大学学报,2014,54(12):56-58.
[17] 孙振涛,杨春要,韩雪萍,等.地佐辛复合罗哌卡因PCEA对老年患者开胸术后应激反应的影响[J].天津医药,2011,39(11):1055-1056.
[2] 张衍,张辉,岳四海,等.显微外科手术对颅脑肿瘤患者症状缓解情况和生活质量的影响[J].中国实用神经疾病杂志,2016,19(10):53-54.
[3] FU P K,PAN T L,YANG C Y,et al.Carthamus tinctorius L.ameliorates brain injury followed by cerebral ischemia-reperfusion in rats by antioxidative and anti-inflammatory mechanisms[J].Iran J basic Med Sci,2016,19(12):1368.
[4] 郑德利,孟莉,周长浩,等.不同麻醉方案对颅内动脉瘤介入手术患者氧化应激反应的影响[J].重庆医学,2015,44(1):103-106.
[5] 包陈娟.不同剂量地佐辛复合罗哌卡因对臂丛神经阻滞效果的影响[J].广西医科大学学报,2015,32(5):773-775.
[6] 朱新洪.临床神经外科学[M].北京:科学技术文献出版社, 2007:17.
[7] SCHWARZ M,RIVERA G,HAMMOND M,et al.Acousto-optic cerebral blood flow monitoring during induction of anesthesia in humans[J].Neurocriti care,2016,24(3):436-441.
[8] 陶立德,薛同敏,张杰,等.缺血预处理对大鼠缺血再灌注肝组织 NF-κB 表达,炎症及氧化应激反应的影响[J].中国普通外科杂志,2015,24(1):70-73.
[9] 席文娟,赵剑秋,王静,等.地佐辛用于术后镇痛的研究进展[J].医学综述,2015,21(15):2811-2813.
[10] GIRSBERGER SA, SCHNEIDER MP, LOFFEL LM, et al.Effect of thoracic epidural ropivacaine versus bupivacaine on lower urinary tract function:a randomized clinical trial[J].Anesthesiology,2018,128(3):511-519.
[11] 邵明璐,李洋,崔华峰,等.针刺预处理对大鼠心肌缺血再灌注氧化应激损伤的保护作用[J].中国针灸,2017,37(3):285-290.
[12] MOHAMMADI M T,DEHGHANI G A.Nitric oxide as a regulatory factor for aquaporin-1 and 4 gene expression following brain ischemia/reperfusion injury in rat[J].Pathology-Res Pract,2015,211(1):43-49.
[13] 贾献辉,叶常红.罗哌卡因与地佐辛联合使用对颅脑外科 ASA Ⅰ,Ⅱ 级患者全麻恢复期躁动的影响[J].中国生化药物杂志,2016,36(1):89-91.
[14] 陶立德,薛同敏,张杰,等.缺血预处理对大鼠缺血再灌注肝组织 NF-κB 表达,炎症及氧化应激反应的影响[J].中国普通外科杂志,2015,24(1):70-73.
[15] 谭志勇.急性脑卒中患者血清炎症细胞因子水平变化及临床意义[J].西南国防医药,2016,26(10):1107-1110.
[16] 郭丹,陶晓三,邓捩根.罗哌卡因和地佐辛超前镇痛对手术后血浆IL-1的影响[J].南昌大学学报,2014,54(12):56-58.
[17] 孙振涛,杨春要,韩雪萍,等.地佐辛复合罗哌卡因PCEA对老年患者开胸术后应激反应的影响[J].天津医药,2011,39(11):1055-1056.