无痛胃镜检查中丙泊酚复合不同类型阿片类药物对炎症应激反应的影响

Effects of propofol combined with different types of opioids on inflammatory stress response in painless gastroscopy

目的:研究无痛胃镜检查中丙泊酚复合不同类型阿片类药物对炎症应激反应的影响。方法:选择本院进行的无痛胃镜病例进行回顾分析,根据选用阿片类药物的不同选择使用盐酸纳布啡、地佐辛、舒芬太尼的患者,分别纳入研究的A、B、C三组。胃镜检查前及检查后6小时,测定血清中炎症细胞因子、氧化应激产物的含量以及外周血中炎症通路分子、抗氧化通路分子的表达量。结果:三组患者胃镜检查后血清中HMGB-1、TNF-α、IFN-γ、CRP、MDA、OH^-、O_2^-的含量以及外周血中RhoA、ROCK、Wnt3a、β-catenin、JNK、ERK1/2、Nrf2、ARE、HO-1、γ-GCS、Prx1的表达量均较胃镜检查前升高(P<0.05),且A组患者胃镜检查后血清中HMGB-1、TNF-α、IFN-γ、CRP、MDA、OH^-、O_2^-的含量以及外周血中RhoA、ROCK、Wnt3a、β-catenin、JNK、ERK1/2的表达量低于B组及C组,外周血中Nrf2、ARE、HO-1、γ-GCS、Prx1的表达量高于B组及C组(P<0.05)。结论:无痛胃镜检查中丙泊酚复合盐酸纳布啡能够较地佐辛、舒芬太尼更为有效地减轻炎症应激反应。

Objective：To study the effects of propofol combined with different types of opioids on inflammatory stress response in painless gastroscopy.Methods：Patients who underwent painless gastroscopy in our hospital between August 2014 and January 2018 were retrospectively analyzed,divided into those with nalbuphine hydrochloride,dezocine and sufentanil according to different choice of opioids and included in group A,group B and group C of the study,respectively.The contents of inflammatory cytokines and oxidative stress products in serum as well as the expression levels of inflammatory pathway molecules and antioxidant pathway molecules in peripheral blood were measured before and 6 hours after gastroscopy.Results：HMGB-1,TNF-α,IFN-γ,CRP,MDA,OH^- and O2^- contents in serum as well as RhoA,ROCK,Wnt3a,β-catenin,JNK,ERK1/2,Nrf2,ARE,HO-1,γ-GCS and Prx1 expression in peripheral blood of three groups of patients after gastroscopy were higher than those before gastroscopy（P〈0.05）,and HMGB-1,TNF-α,IFN-γ,CRP,MDA,OH^- and O2^- contents in serum as well as RhoA,ROCK,Wnt3a,β-catenin,JNK and ERK1/2 expression in peripheral blood of group A after gastroscopy were lower than those of group B and group C whereas Nrf2,ARE,HO-1,γ-GCS and Prx1 expression in peripheral blood were higher than those of group B and group C（P〈0.05）.Conclusion：Propofol combined with nalbuphine hydrochloride can be more effective than dezocine and sufentanil to reduce the inflammatory stress response in painless gastroscopy.