瑞芬太尼控制性降压对手术患者免疫应答及肾素—血管紧张素—醛固酮系统的影响

发布时间：2018-07-04 07:53

本文选题：控制性降压 + RAAS系统　；参考：《川北医学院》2017年硕士论文

【摘要】：目的:比较肝叶切除手术中采用瑞芬太尼控制性降压与硝普钠控制性降压对病人心率、血压、肾素-血管紧张素Ⅱ-醛固酮系统、CD3+T细胞、CD4+T细胞、CD8+T细胞、NK细胞、IL-2、IL-6和TNF-α的影响,评价两者的免疫抑制作用。方法:42例择期行肝叶切除术的患者,ASAⅠ-Ⅱ级,随机分为3组:瑞芬太尼控制性降压组(R组)、硝普钠控制性降压组(N组)和生理盐水空白对照组(C组),分别于麻醉诱导前(T0)、降压前即刻(T1)、降压达目标血压后10 min(T2)、30 min(T3)和停止降压后20 min(T4)时,记录MAP、HR,同时抽取动脉血样用免疫发光法检测血浆中肾素、血管紧张素Ⅱ、醛固酮含量;于麻醉前(T0)、控制性降压后30 min(T3)、手术结束时(T5)、术后第1(T6)、第3(T7)抽取外周静脉血测定CD3+、CD4+、CD8+、CD4+/CD8+和NK细胞的数量及IL-2、IL-6、TNF-α的浓度。结果:R组和N组均能达到很好的控制性降压效果;(1)血流动力学方面:T2、T3时,R组MAP、HR较N组、C组明显降低,且低于组内各时点(P0.05),而N组HR明显高于R组、C组及组内各时点,C组MAP高于R组和N组,C组HR高于R组且低于N组(P0.05);T4,MAP R组和C组无明显差异,而N组明显高于C组和R组,且高于本组内各时点(P0.05)。(2)RAAS系统方面:T2-T4,肾素、血管紧张素Ⅱ、醛固酮R组和C组无明显统计学差异(P0.05),N组肾素、血管紧张素Ⅱ明显高于组内各时点,且高于R组和C组(P0.05);T3、T4时,N组醛固酮高于组内T0、T1、T2且高于R组和C组(P0.05)。(3)免疫学方面:T3、T5时,R组CD3、CD8明显低于组内各时点(P0.05),T3时点,R组CD3、CD8明显低于其余两组,N组、C组TNF-a明显高于组内各时点且高于R组(P0.05);T5时点,N组和C组CD3、R组CD4、IL-2低于组内各时点(P0.05),三组TNF-α明显高于组内各时点且N组高于其余两组(P0.05);T6、T7时,三组IL-6均明显高于组内各时点,N组明显高于其余两组(P0.05)。结论:瑞芬太尼控制性降压能较好的抑制RAAS系统的激活,减少促炎性因子IL-6、TNF-α的生成,对T淋巴细胞的抑制作用较弱,抑制效果可在术后24小时内消除,不影响患者术后恢复,较硝普钠有更好的器官保护作用。
[Abstract]:Objective: To compare the effects of remifentanil controlled hypotension and sodium nitroprusside controlled hypotension on heart rate, blood pressure, renin angiotensin II aldosterone system, CD3+T cells, CD4+T cells, CD8+T cells, NK cells, IL-2, IL-6 and TNF- alpha in patients with hepatic lobectomy, and to evaluate the immunosuppressive effect of the 42 patients undergoing selective hepatic lobectomy The patients, ASA I - II, were randomly divided into 3 groups: Remifentanil controlled hypotension group (group R), sodium nitroprusside controlled hypotension group (group N) and normal saline blank control group (group C), before induction of anesthesia (T0), immediate (T1) before hypotension, 10 min (T2), 30 min (T3) after the target blood pressure, and 20 min (T4) after stopping blood pressure. Blood samples were used to detect plasma renin, angiotensin II, aldosterone content, before anesthesia (T0), 30 min (T3) after controlled hypotension, at the end of the operation (T5), first (T6) after operation, third (T7), and third (T7) to determine the number of CD3+, CD4+, CD8+, CD4+/CD8+ and NK cells and the concentration of IL-2. (1) hemodynamics: T2, T3, R group MAP, HR more than N group, C group obviously lower, and lower than the group time point (P0.05), N group HR obviously higher than R group, C group and the group at each time point, higher than the group and lower than the group. Significantly higher than group C and group R, and higher than the time point in the group (P0.05). (2) RAAS system aspects: T2-T4, renin, angiotensin II, aldosterone R group and C group no significant statistical difference (P0.05), N group renin, angiotensin II is significantly higher than the group of R and C group (P0.05). (3) C (P0.05). (3) immunology: T3, T5, R group CD3, CD8 obviously lower than each time point within the group (P0.05), T3 time point, R group CD3, CD8 obviously lower than the other two groups. At the time point and N group higher than the other two groups (P0.05), T6, T7, three groups of IL-6 were significantly higher than the group at all time points, N group significantly higher than the other two groups (P0.05). Conclusion: Remifentanil controlled hypotension can better inhibit the activation of RAAS system, reduce the proinflammatory factor IL-6, TNF- a, the inhibition of T lymphocyte is weak, inhibition effect can be performed in the operation. Elimination within 24 hours did not affect postoperative recovery, and had better organ protection than sodium nitroprusside.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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