靶控输注依托咪酯联合瑞芬太尼对老年手术患者机体免疫及应激反应指标的影响

发布时间：2018-02-07 11:06

本文关键词： 靶控输注依托咪酯瑞芬太尼免疫指标应激反应老年手术患者　出处：《中国药房》2017年15期 　论文类型：期刊论文

【摘要】：目的:探讨靶控输注依托咪酯联合瑞芬太尼对老年手术患者机体免疫及应激反应指标的影响。方法:60例择期老年手术患者随机分为对照组(n=30)和观察组(n=30)。对照组患者给予丙泊酚注射液1.5~2 mg/kg,静脉注射;观察组患者给予注射用盐酸瑞芬太尼,泵注量为0.5μg/(kg·min),然后靶控输注依托咪酯注射液0.1~0.3 mg/kg,术中根据患者肢体活动情况追加依托咪酯注射液0.05~0.1 mg/kg。比较两组患者术后睁眼时间、定向力恢复时间和拔管时间,免疫指标(CD4~+、CD8~+和CD4~+/CD8~+)及应激反应指标[去甲肾上腺素(NE)、肾上腺素(E)和皮质醇(Cor)]水平,同时记录不良反应发生情况。结果:观察组患者术后睁眼时间、定向力恢复时间和拔管时间均显著短于对照组,差异均有统计学意义(P0.05)。手术前,两组患者CD4~+、CD8~+和CD4~+/CD8~+水平比较,差异均无统计学意义(P0.05);手术后,两组患者CD4~+、CD8~+水平均显著高于同组手术前,且观察组显著高于对照组,CD4~+/CD8~+显著低于同组手术前,且观察组显著低于对照组,差异均有统计学意义(P0.05)。手术前,两组患者NE、E、Cor水平比较,差异均无统计学意义(P0.05);手术后,两组患者NE、E、Cor水平均显著高于同组手术前,但观察组显著低于对照组,差异均有统计学意义(P0.05)。两组患者手术过程中均未见明显不良反应发生。结论:老年手术患者围术期采用靶控输注依托咪酯联合瑞芬太尼麻醉效果理想,可显著改善患者相关免疫指标及应激反应指标水平,且安全性较好。
[Abstract]:Objective: to investigate the effect of target controlled infusion of etomidate combined with remifentanil on body immunity and stress response in elderly patients undergoing surgery. Methods: 60 elderly patients undergoing elective surgery were randomly divided into two groups: control group (n = 60) and observation group (n = 30). Patients were given propofol injection 1.5 mg / kg intravenously; The patients in the observation group were given remifentanil hydrochloride for injection, the pump volume was 0.5 渭 g / kg 路min ~ (-1), then the target controlled infusion of etomidate was 0.1 ~ 0.3 mg / kg 路min ~ (-1). According to the limb movement of the patients, the dosage of etomidate injection was 0.05 ~ 0.1 mg 路kg ~ (-1) 路min ~ (-1). The time of eye opening was compared between the two groups. The recovery time of directional force and extubation time, immunological index CD4 ~ + CD8 ~ and CD4 ~ / CD8 ~) and stress response index [NE (epinephrine) and cortisone] were measured. Results: the time of eye opening, recovery of directional force and extubation time in the observation group were significantly shorter than those in the control group, and the difference was statistically significant (P 0.05). Before operation, the levels of CD4 ~ + CD8 ~ and CD4 ~ / / CD8 ~ ~ were compared between the two groups. After operation, the levels of CD4 ~ + CD8 ~ in the two groups were significantly higher than those in the same group, and the levels of CD4 ~ / / CD8 ~ in the observation group were significantly higher than those in the control group, and were significantly lower in the observation group than in the control group. Before operation, there was no significant difference in the level of NEE Cor between the two groups. After operation, the level of NEE Cor in the two groups was significantly higher than that in the same group, but the level in the observation group was significantly lower than that in the control group. The difference was statistically significant (P 0.05). There were no significant adverse reactions in the two groups. Conclusion: target controlled infusion of etomidate combined with remifentanil is effective in the perioperative period. It can improve the level of related immune index and stress response index, and the safety is better.
【作者单位】：唐山市人民医院;
【基金】：唐山市科学技术研究与发展指导计划项目(No.12130295b)
【分类号】：R614

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