喷他佐辛减轻甲状腺癌手术应激反应的临床研究

Clinical research on pentazocine in reducing stress reaction to thyroid carcinoma surgery

目的探讨喷他佐辛联合丙泊酚能否通过抑制诱导性一氧化氮合酶(iNOS)减轻甲状腺癌手术患者应激反应。方法随机将100例甲状腺癌手术患者分为对照组和干预组,麻醉维持分别静脉给予丙泊酚和喷他佐辛联合丙泊酚。分别测定两组麻醉前、麻醉1 h及手术结束后的心率(HR)、平均动脉压(MAP)、收缩压(SBP)和舒张压(DBP)水平,以及血MDA水平和SOD活性。同时使用RT-PCR法测定麻醉前和麻醉1 h时患者血iNOS mRNA的表达水平。结果在麻醉1 h和手术结束后,两组HR、MAP、SBP和DBP均较麻醉前明显升高(P<0.05),而对照组比干预组升高更显著(P<0.05);在麻醉1 h和手术结束后,两组血MDA水平较麻醉前升高,血SOD活性下降(P<0.05),但与干预组相比较,对照组改变更显著(P<0.05);在麻醉1 h,两组血iNOS mRNA的表达水平较麻醉前明显升高(P<0.05),但对照组比干预组升高更明显(P<0.05)。结论喷他佐辛联合丙泊酚进行麻醉,可能是通过抑制iNOS改善了甲状腺癌手术患者应激反应水平。

Objective To explore the possibility of pentazocine combined with propofol in reducing stress reaction to thyroid carcinoma surgery by inhibiting iNOS. Methods 100 patients with thyroid carcinoma were randomly divided into 2 groups：treatment group（ pentazocine＋propofol）and control group（ propofol only）;the maintenance of anesthesia in treatment group was performed with pentazocine ＋ propofol,while that in control group was performed with propofol only;HR,MAP,DBP and SBP,and the serum levels of MDA and SOD of the patients in both groups were measured before anesthesia,1 hour after anesthesia and at the end of operation;RT-PCR was applied to detect the mRNA expression of iNOS of the patients before anesthesia and 1 hour after anesthesia. Results HR, MAP,DBP and SBP of the patients in both groups 1 hour after anesthesia and at the end of operation were obviously higher than those before anesthesia,while above indexes in control group were even higher than those in treatment group（P﹤0. 05）;the serum level of MDA of the patients in both groups 1 hour after anesthesia and at the end of operation was higher than that before anesthesia,while the serum level of SOD was lower（P﹤0. 05）,and the changes in control group was more significant than those in treatment group（P﹤0. 05）;the mRNA expression of iNOS 1 hour after anesthesia in both groups increased much more than that before anesthesia,while the increase in control group was more obvious than that in treatment group（P﹤0. 05）. Conclusions Pentazocine combined with propofol can reduce stress reaction in patients receiving thyroid carcinoma surgery by inhibiting iNOS.