两种不同麻醉方式 应激反应的影响

Effectof2differentanesthesiamethodsonstressresponseinneurosurgicalpatientswithhypertensionornormal

AprospectiveclinicaltrialMedicine.95(35):e4769,August2016YingChen,MDa,ShanJiang,MDb,YongWu,MDa,Speaker:liujie2016.10.31IntroductionstressresponseNeurosurgerytrauma,anesthesia,hypoxia,andpaincanmakethebodyproducethestressresponsebodyproducesseveremetabolicandhomeostasisdisordersandimmunesuppressionleadingtomassivereleaseofhormonesandbloodsugarintothebloodcausingseriousphysiologicaldysfunction,inflammation,andproliferation（增生）high-sensitivityC-reactiveprotein(Hs-CRP)（超敏C反应蛋白）concentrationincreasingdramaticallymightbeasensitiveindicatorofinflammationandtissuedamage.Introductionhypertensionhypertensionisaspecialdisease,especiallylong-termhighbloodpressurebodyfunctionsaredegradedcorrespondingpathologicalchangeshypertensionpatientsaremorelikelytohavestrongstressresponsecausedbyinjuryofsurgeryoperationcomparedwithnon-hypertensionpatientsIntroductionanesthesiamethodsTheanesthesiamethodsmayhaveconsiderableinfluenceonthesurgicalstressresponseandthepostoperativeimmuneresponseSurgery-inducedinflammatoryresponseandalterationincell-mediatedimmunityseemtobemorepronouncedafterbalancedanesthesiabyenhancingstressresponse.Thebenefitoftotalintravenousanesthesiamightcontributetothepreventionofexcessivepostoperativeinflammation.IntroductiontherelationshipbetweenhypertensionandanesthesiamethodsisunclearonthestressresponseThepurposeofthisstudyistocomparetheeffectofdifferentanesthesiamethodsonhigh-sensitivityC-reactiveprotein(Hs-CRP),bloodglucose,andleucocytelevelsinneurosurgicalpatientswithhypertensionornormal.MaterialsandmethodsSubjectsEightyelectiveneurosurgicalpatientsaged40to65intracranialaneurysmsurgery（脑动脉瘤手术),sellar(蝶鞍区）surgery,meningioma（脑膜瘤）surgery,orcerebraldecompression（减压术）ThepatientswithhypertensionhadbeendiagnosedwithstageIhypertensionforatleast1yearandthebloodpressurewasundercontrolwithmedication.hadnottakenanyothermedicationthatinfluencedtheflowdynamicsrecentlybesidesthehypertensiondrugs.Thebloodpressureofhypertensionpatientsmustbecontrolledat140/90mmHgbeforethesurgeryand180/110mmHgduringthesurgery.AllpatientswithgeneralanesthesiaforendotrachealintubationMaterialsandmethodsSubjectsrandomlydividedintofourgroups:balancedanesthesiagroup(A),balancedanesthesiawithhypertensiongroup(B),totalintravenousanesthesiagroup(C)andtotalintravenousanesthesiawithhypertensiongroup(D)MaterialsandmethodsSubjectsPatientswithendocrinesystemdisease,respiratorysystemdisease,seriouscardiovasculardisease,liverandkidneydysfunction,obesity,andcachexia（恶病质）wereexcludedPatientscouldn’thavehistoryofdrugoralcoholaddictionandpsychiatricdisordersMaterialsandmethodsAnesthesiavenousinfusionpathwaywasestablished30minutesbeforeanesthesiaphenobarbitalsodiuminjection0.02mg/kg,atropine0.007to0.01mg/kginductionofgeneralanesthesia:midazolam0.05to0.1mg/kg,fentanyl,4ug/kg,and2to3mg/kgofpropofol,atracurium0.5to0.6mg/kgunderwentrapidinductionandtrachealintubationmechanicalventilationMaterialsandmethodsAnesthesiatotalintravenousanesthesia:fentanyl0.05to0.10ug/kg/min,3to4mg/kg/hpropofolinfusionmaintained;balancedanesthesia:isofluraneinhalation,andintermittentintravenousfentanyl1to2mg/kg.Eachgroupmaintainedmusclerelaxationwithatracurium0.2to0.3mg/kgcontinuousinfusion.MaterialsandmethodsAnesthesiaAllpatientswerecontinuouslymonitoredheartrate,bloodpressure,respirationrate,andbloodoxygensaturation.Thebloodpressurewasmaintainedatbetween140and120/90and70mmHgcontinuousintravenousnitroglycerinweregivenifthemalignantbloodpressureemerged,djustedbythebloodpressurechangestokeepbloodpressurestable.OtherspecialistcareandspecialtreatmentwereconductedasusualMaterialsandmethodsDetectionmethodandtheobservationindexextractedveinblood5mLat4times:beforesurgery(T0),duringsurgery(T1),2hoursaftersurgery(T2),and24hoursaftersurgerySerumlevelsofhighsensitiveC-reactiveproteinwasdetectedbyenzyme-linkingimmune-absorbentassay(酶联免疫吸附试验，ELISA）Thelevelsofbloodglucoseandleukocytecountweremeasuredrespectivelybybloodglucosemeterandautomaticbloodcellcountingequipment.MaterialsandmethodsStatisticalanalysisMeanandstanddeviationateachmeasuretimewithingroupwerereported.TwosidedpairedttestwasconductedtocomparethemeanbetweentimeT0withothertimeswithinthesamegroup.One-wayanalysisofvariance(ANOVA)wasusedtotestwhethertherewasanysignificantdifferencebetweenthehypertensionandnon-hypertensiongroupsbeforethesurgery.Two-wayANOVAwasperformedtoexaminetheinfluenceofanesthesiamethodandhypertensionhistoryontheinterestedoutcomes.SPSS13.0(SPSSInc.,Chicago,IL)wasusedtoperformthestatisticalanalysesResultsDemographicdata:nodifferenceTable1Demographicdataofpatients(x±S,n=20).

Group Age,ySex(M/F)Weight,g

Bloodloss,mL

Durationofsurgery,hA 55±6.38/1264±9.6

343±102.4

3.3±0.8B 54±4.911/962±8.7

366±135.6

3.2±0.7C 52±8.110/1063±10.2

358±118.3

3.5±0.4D 57±5.511/965±9.3

349±129.7

3.3±0.6ResultsHs-CRPexpressionHs-CRPexpressionintheA,B,C,andDgroupsdecreasedatT0,T1,T2timepoint,butincreasedatT3(?)attimeT0,PatientswithhypertensionhadhigherHs-CRPexpressionthanthoseofnormal

(P<0.01)patientswithhypertension