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
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篇名: 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
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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0.5 μg/(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(P<0.05)。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(P>0.05);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(P<0.05)。手术前,两组患者NE、E、Cor水平比较,差异均无统计学意义(P>0.05);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(P<0.05)。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 effects of target-controlled infusion of etomidate combined with remifentanil on indexes of immune and stress response in elderly surgery patients. METHODS: Totally 60 patients undergoing elective surgery were randomly divided into control group (n=30) and observation group (n=30). Control group was given Propofol injection 1.5-2 mg/kg intravenously. Observation group was given Remifentanil hydrochloride for injection with pump volume of 0.5 μg/(kg·min), and then target controlled infusion of Etomidate injection 0.1-0.3 mg/kg; the dose of etomidate increased by 0.05-0.1 mg/kg according to physical activity during surgery. Postoperative eye opening time, recovery time of orientation and extubation time were compared between 2 groups as well as the levels of immune indexes (CD4+, CD8+,CD4+/CD8+),stress response indexes [serum norepinephrine (NE), adrenaline (E) and cortisol (Cor)]. The occurrence of ADR was recorded during surgery. RESULTS: Postoperative eye opening time, recovery time of orientation and extubation time in observation group were significantly shorter than control group, with statistical significance (P<0.05). Before surgery, there was no statistical significance in CD4+,CD8+ and CD4+/CD8+ between 2 groups(P>0.05). After surgery, CD4+ and CD8+ of 2 groups were significantly higher than before surgery, and the observation group was significantly higher than the control group, CD4+/CD8+ of 2 groups was significantly lower than before,and the observation group was significantly lower than control group, with statistical significance (P<0.05). Before surgery, there was no statistical significance in the levels of NE, E and Cor between 2 groups (P>0.05); after surgery, the levels of NE, E and Cor in 2 groups were significantly higher than before surgery, but the observation group was significantly lower than the control group, with statistical significance (P<0.05). There were no obvious adverse reaction occurred in 2 groups during the surgery. CONCLUSIONS: The target-controlled infusion of etomidate combined with remifentanil is ideal for perioperative anaesthesia in the elderly patients and effectively improves related immune indexes and stress response indexes with good safety.
期刊: 2017年第28卷第15期
作者: 柴林,刘智慧,郑智文,解志强,李海燕
AUTHORS: CHAI Lin,LIU Zhihui,ZHENG Zhiwen,XIE Zhiqiang,LI Haiyan
关键字: 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
KEYWORDS: Target-controlled infusion; Etomidate; Remifentanil; Immunity; Stress response; Elderly; Surgery patient
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