丙泊酚静脉麻醉对骨科手术患者麻醉效果及炎性细胞因子的影响

李顺利

摘要：目的  探討丙泊酚静脉麻醉对骨科手术患者麻醉效果及炎性细胞因子IL-6、IL-10和TNF-α浓度的影响。方法  选取2018年1月～2019年12月我院收治的106例骨科手术患者，按随机数字表法分为对照组和研究组，每组53例。对照组使用七氟醚吸入麻醉，研究组使用丙泊酚静脉麻醉，比较两组麻醉效果、血清氧化应激反应变化情况、血流动力学变化情况、血清炎性细胞因子水平变化情况。结果  研究组拔管后镇静评分低于对照组，拔管时间、麻醉苏醒时间短于对照组，差异有统计学意义（P<0.05）;两组术后2 h SOD较术前下降，MDA、NO较术前上升，研究组术后2 h SOD高于对照组，MDA、NO低于对照组，差异有统计学意义（P<0.05）;研究组插管即刻、插管后即刻HR低于对照组，差异有统计学意义（P<0.05）;研究组术后2、24 h TNF-α、IL-6水平均低于对照组，IL-10水平高于对照组，差异有统计学意义（P<0.05）。结论  骨科手术患者使用丙泊酚静脉麻醉可缩短麻醉苏醒时间，降低氧化应激反应，对血流动力学影响较小，可有效抑制术后炎症的发生，麻醉效果确切。

关键词：炎性细胞因子;丙泊酚;七氟醚;静脉麻醉;血流动力学

中图分类号：R971+.2                                文献标识码：A                                DOI：10.3969/j.issn.1006-1959.2020.23.044

文章编号：1006-1959（2020）23-0150-04

Abstract：Objective  To explore the effect of propofol intravenous anesthesia on the anesthesia effect and the concentration of inflammatory cytokines IL-6， IL-10 and TNF-α in orthopedic surgery patients.Methods  A selection of 106 orthopedic surgery patients admitted to our hospital from January 2018 to December 2019 were divided into a control group and a study group according to a random number table， with 53 cases in each group. The control group used sevoflurane inhalation anesthesia， and the study group used propofol intravenous anesthesia. The anesthesia effects， changes in serum oxidative stress， changes in hemodynamics， and changes in serum inflammatory cytokine levels were compared between the two groups.Results  The sedation score after extubation in the study group was lower than that in the control group， and the extubation time and the time to wake up from anesthesia were shorter than those in the control group，the difference was statistically significant （P<0.05）; the SOD of the two groups decreased at 2 h after the operation， and the MDA and NO increased compared with that before the operation. The SOD of the study group was higher than the control group at 2 h， and the MDA and NO were lower than the control group，the difference was statistically significant （P<0.05）;The HR of the study group immediately after intubation and immediately after intubation was lower than that of the control group， the difference was statistically significant （P<0.05）; the levels of TNF-α and IL-6 in the study group were lower than those of the control group at 2 and 24 h after operation. The level of 10 was higher than that of the control group，the difference was statistically significant （P<0.05）.Conclusion  Propofol can shorten the anesthesia recovery time and reduce oxidative stress response in patients undergoing orthopedic surgery under intravenous anesthesia. It has little influence on hemodynamics， effectively inhibits postoperative inflammation， and has a significant anesthetic effect.

Key words：Inflammatory cytokines;Propofol;Sevoflurane;Intravenous anesthesia;Hemodynamics

骨科手术术前、术后的插管、拔管会强烈刺激机体，且术后疼痛明显，手术创伤较大，均易导致患者发生炎性反应、全身应激反应，出现术后并发症，如切口愈合不良、感染等，对患者的身心健康、生活质量造成严重影响[1]。手术过程中麻醉药物会使机体释放多种活性物质，增强机体交感神经兴奋性，引发血流动力学波动[2]。因此，为骨科手术患者选择更加稳定的麻醉方法，稳定患者血流动力学，降低患者全身应激反应具有重要意义[3]。随着医疗技术的不断发展，麻醉诱导技术有很大进步，麻醉诱导期患者的心血管反应可以通过选择合适的麻醉诱导药物加以改善[4]。七氟醚吸入麻醉是传统的麻醉诱导方式，受多种因素影响，可能会影响患者脑代谢，增加患者颅内压力，而丙泊酚具有连续、短期、快速输注、无积聚等特点，常用于患者术后镇静、麻醉诱导[5]。……