全身麻醉患者内源性阿片肽含量变化及影响因素初探

发布时间：2018-05-01 06:23

本文选题：全身麻醉 + 围术期　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:1.观察全身麻醉患者麻醉手术前后外周血白细胞数量及白细胞源性b-内啡肽(b-endorphin,b-EP)和血浆b-EP、亮氨酸脑啡肽(leuthine enkephalin,LEK)含量变化。2.探讨去甲肾上腺素(Noradrenaline,NE)对白细胞源性b-EP的影响。方法:1.选择静脉全身麻醉下行择期手术患者48例,记录麻醉手术前后外周血白细胞(white blood cell,WBC)总数及分类计数、百分比。于麻醉开始前(T1)、麻醉结束患者清醒后(T2)采集肘静脉血4 ml,流式细胞术检测白细胞中b-EP荧光阳性细胞百分数和平均荧光强度(mean fluorescence intensity,MFI),放射免疫分析法(radioimmunoassay,RIA)测定血浆b-EP、LEK水平。2.1 ml外周血(麻醉前血样)中加入去甲肾上腺素4μg(浓度10-5 mol/L),观察药物加入前(T0)、加药即刻(T1)、30 min(T2)、1 h(T3)、2 h(T4)白细胞内b-EP平均荧光强度(MFI)变化。结果:1.与麻醉开始前相比,麻醉结束患者清醒后WBC总数、粒细胞(granulocyte,G)和单核细胞(monocyte,Mon)计数显著增加(P0.01),淋巴细胞(lymphocyte,Lym)计数显著降低(P0.01);中性粒细胞百分比明显增高(P0.01),淋巴细胞百分比明显降低(P0.01),单核细胞百分比无明显变化。中性粒细胞与淋巴细胞比值(Neutrophil-lymphocyte ratio,NLR)明显增高(P0.01)。麻醉手术后各类白细胞b-EP平均荧光强度(MFI)较术前均显著降低(P0.05)。粒细胞含b-EP荧光阳性细胞百分数降低最为显著(P0.05),淋巴细胞和单核细胞呈下降趋势。麻醉手术后血浆b-EP、LEK水平显著下降(P0.01)。2.离体外周血加入去甲肾上腺素,作用30 min时,粒细胞、单核细胞和淋巴细胞内b-EP平均荧光强度(MFI)呈增高趋势;随着作用时间延长,b-EP平均荧光强度又逐渐降低,但差异无统计学意义(P0.05)。结论:1.手术麻醉后患者外周白细胞数目增加,以粒细胞为主,淋巴细胞数目降低;外周血白细胞源性及血浆内源性阿片肽水平降低。2.去甲肾上腺素短时间作用可使白细胞内b-EP表达呈增加趋势。
[Abstract]:Purpose 1. To observe the changes of leucocyte count, leucine enkephalin and leucine enkephalin leucine before and after general anesthesia in patients with general anesthesia before and after operation. The changes of plasma b-EP, leucine enkephalin and leucine-enkephalin leucine (Leucine enkephalin leucine) were observed before and after anesthesia. Objective: to investigate the effect of noradrenaline (NE) on leukocyte derived b-EP. Method 1: 1. Forty-eight patients undergoing elective operation under intravenous general anesthesia were selected to record the total white blood cell count and the percentage of white white blood before and after anesthesia. Blood samples of cubital vein were collected from 4 ml of cubital vein blood before anaesthesia began. The percentage of b-EP fluorescence positive cells in leukocytes and the mean fluorescence intensity of MFI were detected by flow cytometry. Radioimmunoassay was used to detect b-EPTLEK in plasma by radioimmunoassay (radioimmunoassay). The changes of b-EP mean fluorescence intensity (MFI) in leukocytes were observed by adding noradrenaline 4 渭 g (concentration 10-5 mol / L ~ (-1) into peripheral blood (blood sample before anesthesia). The result is 1: 1. Compared with before anaesthesia, the total number of WBC after anaesthesia ended, The count of granulocyteteg (GN) and monocyte (monocyte) increased significantly (P 0.01), and lymphocyte (Lym) decreased significantly (P 0.01), while the percentage of neutrophil increased significantly (P 0.01), and the percentage of lymphocytes decreased significantly (P 0.01), but the percentage of monocytes did not change significantly. The ratio of neutrophil-lymphocyte to neutrophil-lymphocyte (NLRR) was significantly higher than that of neutrophilic lymphocyte (NLRR). The mean fluorescence intensity of b-EP in all kinds of leukocytes after anesthesia was significantly lower than that before operation (P 0.05). The percentage of b-EP positive cells in granulocytes decreased most significantly (P 0.05), and the lymphocytes and monocytes showed a decreasing trend. After anesthesia, the plasma level of b-EPL-LEK decreased significantly (P 0. 01 卤0. 02). The mean fluorescence intensity of b-EP in granulocytes, monocytes and lymphocytes increased with the addition of norepinephrine in peripheral blood for 30 min, and decreased gradually with the prolongation of action time. But the difference was not statistically significant (P 0.05). Conclusion 1. The number of peripheral white blood cells increased, mainly granulocyte, the number of lymphocytes decreased, and the levels of peripheral leukocyte derived and plasma endogenous opioid peptide decreased. The effect of norepinephrine on the expression of b-EP in leukocytes for a short time showed an increasing trend.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614.2

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