不同吸入麻醉药对颅内肿瘤患者血浆炎性因子的影响

发布时间：2018-03-21 16:59

本文选题：七氟醚　切入点：异氟醚　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：本文旨在通过观察颅内肿瘤患者在围术期应用七氟醚、异氟醚吸入麻醉时患者血浆炎性因子的差异，从而比较七氟醚与异氟醚对颅内肿瘤患者术后抗感染能力的影响，进而在细胞因子水平上反应其对机体免疫功能的影响，为颅内肿瘤患者临床麻醉选择用药提供依据。方法：本实验选择择期颅内幕上肿瘤切除术患者30例，男、女各15例，年龄从30岁－65岁之间不等，ASA分级均为I-II级，所有患者随机分为两组，分别为七氟醚组（SEV组）及异氟醚组（ISO组）、每组各15例。所有患者均于入手术室前半小时肌注阿托品0.5mg，入室后开放静脉通路，常规监测血压、心率、血氧饱和度、MAC值等指标。全麻诱导均采用咪哒唑仑0.05mg/kg、丙泊酚2mg/kg、芬太尼2-5μg/kg以及顺阿0.15mg/kg进行诱导插管。术中两组患者分别吸入异氟醚及七氟醚，维持MAC值于1—2MAC之间，并间断静注顺阿及芬太尼维持麻醉，使BIS在40—60。两组患者均在麻醉前（T0）、手术开始后一小时（T1）、手术开始后两小时（T2）术毕（T3）、术后24h(T4)采外周静脉血2ml，高速低温离心机离心10分钟（2000r/min），然后取上清液0.5-1.0ml（血浆）置入EP管中，于-80°C低温冰箱中统一保存，最后集中以ELISA法测定血浆中TNF-α、IL-6及CRP的浓度。结果： 1、血浆TNF-α浓度的变化：血浆TNF-α组内比较：ISO组TNF-α的含量,在T1与T0时间点相比无明显差异（P0.05），在T2、T3时间点明显升高(与T0时间点相比较，P＜0.05), T4时间点较前降低但仍明显高于T0时间点(P＜0.05)。SEV组T1时间点与T0时间点比较血浆中的TNF-a显著升高(P＜0.05)，T2、T3、T4逐渐降低，但仍高于T0时间点(P＜0.05)。组间比较：在T3时间点ISO组TNF-α浓度高于SEV组(P0.05). 2、血浆IL-6浓度的变化：组内比较：在T1、T2、T3时间点SEV及ISO两组患者血浆中的IL-6含量较T0时间点均显著升高（P0.05），在T4时间点逐渐下降，略高于T0水平，但无统计学意义（P0.05）。组间比较：在T3时间点SEV组血浆IL-6浓度低于ISO组（P0.05）。 3、血浆CRP浓度的变化：组内比较：在T1时间点两组患者血浆中CRP的含量，较T0时间点均无显著差异（P0.05），其后逐渐升高,至T3时间点达到峰值（P0.05），于T4时间点时均回降至T0水平（P0.05）。组间比较：T3时间点，两组患者血浆IL-6的浓度SEV组低于ISO组（P0.05）。结论： 1、颅内肿瘤患者应用七氟醚及异氟醚均可抑制促炎性细胞因子TNF-α、IL-6以及炎症介质CRP的产生。对肿瘤患者的免疫功能的恢复具有积极意义。 2、七氟醚较异氟醚能更好的抑制颅内肿瘤患者术中血浆促炎性细胞因子IL-6及炎症介质CRP的分泌、对TNF-α的抑制作用较异氟醚更小而且短暂，，在麻醉的选择上更具优势。
[Abstract]:Objective: to compare the effect of sevoflurane and isoflurane on postoperative anti-infective ability of intracranial tumor patients by observing the difference of plasma inflammatory factors in patients with intracranial tumor during perioperative application of sevoflurane and isoflurane inhalation anesthesia. Furthermore, the effect of cytokines on immune function of patients with intracranial tumors was studied, which provided basis for clinical anesthetic choice in patients with intracranial tumors. Methods: 30 patients (15 males and 15 females) with selective resection of intracranial supratentorial tumors were randomly divided into two groups, with ASA grades ranging from 30 to 65 years old. There were 15 cases in each group. All the patients were injected atropine 0.5 mg half an hour before the operating room. The venous pathway was opened and blood pressure and heart rate were monitored by routine method. General anesthesia induction was performed with midazolam 0.05 mg / kg, propofol 2 mg / kg, fentanyl 2-5 渭 g / kg and cis-0.15 mg / kg respectively. Isoflurane and sevoflurane were inhaled in both groups, and the MAC values were maintained between 1 and 2 MAC. The anesthesia was maintained by intermittent intravenous injection of Sino and fentanyl. BIS was given at 40-600.The patients in both groups were treated with T0 before anesthesia, one hour after operation, one hour after operation, two hours after operation, and two hours after operation. After operation, 2 ml of peripheral venous blood was collected, 24 h after operation, 2 ml of peripheral venous blood was collected, centrifuged by high speed hypothermia centrifuge for 10 minutes, then the supernatant was taken from 0.5 to 1.0 ml (plasma) and placed into EP tube. The concentration of TNF- 伪 IL-6 and CRP in plasma was determined by ELISA method. Results:. 1. The change of plasma TNF- 伪 concentration:. The content of TNF- 伪 in the plasma TNF- 伪 group was compared with that in the control group. There was no significant difference between T 1 and T 0 time points (P 0.05), but there was a significant increase in T 2 T 3 time point (P < 0 05), and a significant decrease in T 4 time point but still higher than that in T 0 time point P < 0.05).SEV group T 1 time point and T 0 time point group compared with T 0 time point P < T 0 time point, the plasma TNF-a in T 1 time point was significantly higher than that in T 0 time point P < T 0 time point P < T 0 time point. The increase of T2T3T4 decreased gradually, P < 0.05, and the level of T3T4 decreased gradually, while that of T2T3T4 decreased gradually. But it was still higher than that of T0 (P < 0.05). Comparison between groups: at T3 time point, the concentration of TNF- 伪 in ISO group was higher than that in SEV group (P 0.05). 2. The change of plasma IL-6 concentration:. Intragroup comparison: the plasma IL-6 levels in SEV and ISO groups were significantly higher than those at T0 time point, and gradually decreased at T4 time point, slightly higher than T0 level, but had no statistical significance. Comparison between groups: at T3 time point, plasma IL-6 concentration in SEV group was lower than that in ISO group (P 0.05). 3. The change of plasma CRP concentration:. Intra group comparison: there was no significant difference in plasma CRP content between the two groups at T1 time point compared with that at T0 time point, then it increased gradually, and reached the peak value at T3 time point, and then decreased to T0 level P0.05a at T4 time point. The plasma IL-6 concentration in the two groups was lower than that in the ISO group (P 0.05). Conclusion:. 1. Both sevoflurane and isoflurane could inhibit the production of TNF- 伪 IL-6 and inflammatory mediator CRP in patients with intracranial tumors. Compared with isoflurane, sevoflurane could inhibit the secretion of plasma pro-inflammatory cytokine (IL-6) and inflammatory mediators (CRP) in intracranial tumor patients. The inhibitory effect of sevoflurane on TNF- 伪 was smaller and shorter than that of isoflurane.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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