丙泊酚或七氟醚对手术患者机体蛋白质代谢的影响
发布时间：2018-12-08 13:11
【摘要】：目的临床研究已表明，不仅降低围术期机体应激反应有助于术后康复和完善手术效果，而且加强围术期营养支持和减少围术期患者机体的分解代谢对其产生的影响也很明显。但目前对不同全身麻醉维持药物对手术患者机体分解代谢及营养状况的影响了解甚少。目前临床上常用的全麻维持药物的复合方式是七氟醚复合瑞芬太尼和丙泊酚复合瑞芬太尼，该课题目的就是比较以上两种全麻维持方式下行经腹会阴联合直肠癌根治术的患者的应激激素、肌肉蛋白质分解代谢和内脏蛋白水平方面的差异。 方法将要行经腹会阴联合直肠癌根治术的54个患者，ASA(American Society Of Anesthesiologists,美国麻醉医师协会)Ⅰ-Ⅲ级，年龄在25~65岁之间。将以上患者随机分为两组:一组接受七氟醚复合瑞芬太尼全麻维持，即七氟醚组（S组，n=27）；另一组接受丙泊酚复合瑞芬太尼静脉全麻维持，即丙泊酚组（P组，n=27）。尿标本自手术切皮时（0h）每小时收集一次(0h，0-1h，1-2h，2-3h，3-4h)，直至手术结束，检测尿液中3-甲基组氨酸与肌酐的比值（3MH/Cr），以此作为反映机体蛋白质分解量的指标。血标本自手术切皮时（0h）每两小时收集一次，直至手术结束，至少收集三次(0h，2h，4h)，，检测血清中胰岛素、皮质醇含量。并于手术切皮时(0h)，术后6h以及术后第1天和术后2天的的清晨抽取空腹静脉血，检测血清内脏蛋白【前白蛋白（prealbumin,PRE）、视黄醇结合蛋白（retinal-bindingprotein,RbP）】的水平。呼吸商（RQ）作为反应机体代谢情况的重要指标，自手术切皮时（0h）每小时记录一次平均值（0h，0-1h，1-2h，2-3h，3-4h），直至手术结束。 结果在两组中，与0h，0-1h的3-MH/Cr值相比，1-2h，2-3h的明显升高。但是丙泊酚组1-2h(15.7vs18.2,P＜0.05)和2-3h(15.9vs18.1,P＜0.05)的3MH/Cr值(nmol/umol)均比七氟醚组低。并且在这两个时间点P组的RQ也比S组要明显降低。两组中的内脏蛋白均在术后两天内持续下降，但是丙泊酚组在术后第2天的下降幅度明显小于七氟醚组。 结论推测因为丙泊酚脂肪乳中的甘油三酯作为供能物质被机体分解利用，从而减少了机体肌肉蛋白的分解，所以丙泊酚组的3-MH/Cr值和呼吸商小于七氟醚组。并且丙泊酚用于全麻维持能有效减小术后体内脏蛋白水平的下降幅度，有利于机体营养状态早日恢复。
[Abstract]:Objective Clinical studies have shown that not only reducing the stress response in perioperative period is helpful to postoperative rehabilitation and improving the effect of surgery, but also strengthening nutritional support during perioperative period and reducing the effect of catabolism on perioperative patients. However, little is known about the effects of different general anesthesia maintenance drugs on catabolism and nutritional status in patients undergoing surgery. At present, sevoflurane combined with remifentanil and propofol combined with remifentanil are commonly used in clinical practice. The aim of this study was to compare the differences in stress hormones, muscle protein catabolism and visceral protein levels in patients undergoing transabdominal perineum combined rectal cancer radical resection under the two general anesthesia maintenance modes. Methods Fifty-four patients (, ASA (American Society Of Anesthesiologists, American Association of Anesthesiologists), aged between 25 and 65 years, who were undergoing radical resection of rectal cancer through abdominal perineum were enrolled in this study. The patients were randomly divided into two groups: one group received sevoflurane combined with remifentanil general anesthesia, namely sevoflurane group (S group, n = 27), the other group received propofol combined remifentanil intravenous general anesthesia maintenance, namely propofol group (P group, n = 27). Urine samples were collected every hour (0 h, 0 h, 1 h, 2 h, 3 h) at the end of operation. The ratio of 3-methylhistidine to creatinine (3MH/Cr) in urine was determined. This is used as an index to reflect the amount of protein decomposition in the body. The blood samples were collected every two hours at the time of skin incision until the end of the operation. The serum insulin and cortisol contents were measured at least three times (0 h / 2 h / h). Fasting venous blood was collected at the time of skin incision (0 h), 6 h after operation, 1 day after operation and 2 days after operation. The serum levels of visceral protein (prealbumin,PRE) and retinol binding protein (retinal-bindingprotein,RbP) were measured. Respiratory quotient (RQ), as an important indicator of metabolism, was recorded once an hour (0 h / h) at the time of skin incision (0 h / h) (0 h / h 0 ~ 1 h) and 2 ~ 2 h / 2 h / 3 h / h, until the end of the operation. Results in the two groups, the 3-MH/Cr value of 1-2hu 2-3h was significantly higher than that of 0hU 0-1h. However, the 3MH/Cr (nmol/umol) of propofol group was lower than that of sevoflurane group at 1-2 h (15.7 vs 18.2) and 2-3 h (15.9 vs 18.1 P < 0.05). The RQ of P group was significantly lower than that of S group at these two time points. The visceral protein in both groups decreased continuously on the 2nd day after operation, but the decrease in propofol group was significantly lower than that in sevoflurane group on the second day after operation. Conclusion because the triglyceride in propofol fat emulsion is decomposed by the body as energy supply, thus reducing the decomposition of muscle protein, the 3-MH/Cr value and respiratory quotient of propofol group are lower than that of sevoflurane group. And propofol used in maintenance of general anesthesia can effectively reduce the decrease of body visceral protein level, which is beneficial to the early recovery of body nutrition.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：2368403
[Abstract]:Objective Clinical studies have shown that not only reducing the stress response in perioperative period is helpful to postoperative rehabilitation and improving the effect of surgery, but also strengthening nutritional support during perioperative period and reducing the effect of catabolism on perioperative patients. However, little is known about the effects of different general anesthesia maintenance drugs on catabolism and nutritional status in patients undergoing surgery. At present, sevoflurane combined with remifentanil and propofol combined with remifentanil are commonly used in clinical practice. The aim of this study was to compare the differences in stress hormones, muscle protein catabolism and visceral protein levels in patients undergoing transabdominal perineum combined rectal cancer radical resection under the two general anesthesia maintenance modes. Methods Fifty-four patients (, ASA (American Society Of Anesthesiologists, American Association of Anesthesiologists), aged between 25 and 65 years, who were undergoing radical resection of rectal cancer through abdominal perineum were enrolled in this study. The patients were randomly divided into two groups: one group received sevoflurane combined with remifentanil general anesthesia, namely sevoflurane group (S group, n = 27), the other group received propofol combined remifentanil intravenous general anesthesia maintenance, namely propofol group (P group, n = 27). Urine samples were collected every hour (0 h, 0 h, 1 h, 2 h, 3 h) at the end of operation. The ratio of 3-methylhistidine to creatinine (3MH/Cr) in urine was determined. This is used as an index to reflect the amount of protein decomposition in the body. The blood samples were collected every two hours at the time of skin incision until the end of the operation. The serum insulin and cortisol contents were measured at least three times (0 h / 2 h / h). Fasting venous blood was collected at the time of skin incision (0 h), 6 h after operation, 1 day after operation and 2 days after operation. The serum levels of visceral protein (prealbumin,PRE) and retinol binding protein (retinal-bindingprotein,RbP) were measured. Respiratory quotient (RQ), as an important indicator of metabolism, was recorded once an hour (0 h / h) at the time of skin incision (0 h / h) (0 h / h 0 ~ 1 h) and 2 ~ 2 h / 2 h / 3 h / h, until the end of the operation. Results in the two groups, the 3-MH/Cr value of 1-2hu 2-3h was significantly higher than that of 0hU 0-1h. However, the 3MH/Cr (nmol/umol) of propofol group was lower than that of sevoflurane group at 1-2 h (15.7 vs 18.2) and 2-3 h (15.9 vs 18.1 P < 0.05). The RQ of P group was significantly lower than that of S group at these two time points. The visceral protein in both groups decreased continuously on the 2nd day after operation, but the decrease in propofol group was significantly lower than that in sevoflurane group on the second day after operation. Conclusion because the triglyceride in propofol fat emulsion is decomposed by the body as energy supply, thus reducing the decomposition of muscle protein, the 3-MH/Cr value and respiratory quotient of propofol group are lower than that of sevoflurane group. And propofol used in maintenance of general anesthesia can effectively reduce the decrease of body visceral protein level, which is beneficial to the early recovery of body nutrition.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
【参考文献】
相关期刊论文 前2条
1 赵宏,常靖,龙路路;吸入氧浓度对全麻病人血浆SOD和MDA的影响[J];临床麻醉学杂志;2002年05期
2 黎介寿;肠内营养——外科临床营养支持的首选途径[J];中国实用外科杂志;2003年02期
本文编号：2368403
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