氟马西尼对丙泊酚复合舒芬太尼全麻患者血浆中食欲素A的影响

Influence of flumazenil on plasma orexin-A level in patients with general anesthesia of propofol combined with sufentanil

目的观察氟马西尼对丙泊酚复合舒芬太尼全身麻醉患者在麻醉恢复期血浆中食欲素A(orexin-A)水平的影响,探讨氟马西尼的促进麻醉苏醒作用是否与orexin-A相关。方法选择全身麻醉下行腹腔镜下子宫肌瘤剥除术或全子宫切除术患者40例,ASA均Ⅰ~Ⅱ级,随机分为氟马西尼组(F组)和生理盐水组(N组),每组20例。全身麻醉后,采用丙泊酚镇静,脑电双频指数(BIS)值维持55~65,术后分别给予静脉注射氟马西尼0.008 mg/kg(F组),或同等剂量的生理盐水(N组)。抽取给药(氟马西尼或生理盐水)前(T0)、给药后5 min(T1)、给药后15 min(T2)、给药后30 min(T3)的桡动脉血3.0 ml,离心后采用ELISA法检测血浆中orexin-A水平,并记录患者呼唤时睁眼时间、拔出气管插管时间。结果两组平均动脉压(MAP)、心率(HR)、BIS在T1、T2、T3时点与T0比较差异均有统计学意义(P均<0.05)。在T1、T2时点F组与N组MAP、HR比较差异有统计学意义(P均<0.05),在T1、T2、T3时点两组BIS值比较差异均有统计学意义(P均<0.05)。两组orexin-A水平在T1、T2、T3时点与T0比较差异均有统计学意义(P均<0.05),在T1、T2、T3时点两组比较差异均有统计学意义(P均<0.05)。两组睁眼时间、拔出气管插管时间比较差异均有统计学意义(P均<0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论氟马西尼可提高丙泊酚复合舒芬太尼全麻患者血浆中orexin-A水平,使麻醉恢复时间缩短。

Objective To observe the influence of flumazenil on plasma orexin-A level during the recovery period of anesthesia in patients with general anesthesia of propofol combined with sufentanil and explore whether the effect of promoting anesthesia recovery of flumazenil was related to orexin-A. Methods Forty patients undergoing laparoscopic hysteromyoma decollement or pan hysteromyoma under general anesthesia with ASA classification Ⅰ-Ⅱ were selected. The patients were randomly divided into two groups （ n = 20 each ） ： flumazenil group （ F group ） and normal saline group （ N group）. After general anesthesia, propofol sedation was given to maintain bispectral index （BIS）at the level of 55 to 65. After operation, intravenous injection of 0. 008 mg/kg flumazenil （ F group ） or the same dose of normal saline （ N group ） was respectively given. Drawing 3.0 ml of radial artery blood at the time points of TO （ before medication of flumazenil or normal saline） , TI （5 min after medication） , T2 （15 rain after medication） and T3 （30 min after medication） , the levels of plasma orexin-A were detected （ by ELISA methods ） after centrifugation. The patients＂ eyes open time in calling and the time pulling out tracheal intubation were recorded. Results There were significant differences in mean artery pressure（MAP） ,heart rate （HR） and B1S between TO time point and T1 ,T2 ,T3 time points in both two groups（ all P 〈0. 05 ）. There were significant differences in MAP and HR at T1 and T2 time points between F group and N group（ all P 〈 0. 05 ）. There were significant differences in BIS values at T1,T2 and T3 time points between two groups （ all P 〈 0. 05 ）. There were significant differences in orexin-A levels between TO time point and T1, T2, T3 time points in both twogroups（all P 〈 0. 05）. There were significant differences in orexin-A levels at T1, T2 and T3 time points between two groups（all P 〈 0.05）. There were significant differences in eyes open time in calling and time pulling out tracheal intubation between two groups （all P 〈 0. 05）. There was no significant difference in postoperative complication rate （P 〉 0. 05）. Conclusion Flumazenil can increase the plasma orexin-A level and shorten the anesthesia recovery time for the patients under general anesthesia with propofol combined with sufentanil.