超快通道麻醉用药对心脏手术患者血清炎性因子的影响

Effect of Ultrafast Pathway Anesthesia on Serum Inflammatory Factors in Patients Undergoing Cardiac Surgery

目的探讨超快通道麻醉用药在心脏手术中的应用价值及其对血清炎性因子水平的影响。方法前瞻性纳入2013年3月至2017年4月行心脏手术的患者200例,按随机数字表法分为对照组与观察组,各100例。对照组患者采用常规麻醉方式,观察组患者接受超快通道麻醉。结果麻醉诱导前(T_0),两组患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心肌肌钙蛋白I(cTnI)水平比较无明显差异(P>0. 05),体外循环后(T_2),两组患者HR,MAP均上升,CVP均下降(P <0. 05),手术结束时(T_3),两组患者HR及MAP均上升(P <0. 05),气管插管后(T_1)至手术结束时(T_3),两组患者cTnI均上升,且观察组患者上升幅度低于对照组患者(P <0. 05);术后1 d,两组患者炎性指标均上升,但观察组均低于对照组(P <0. 05);术后1 d,两组神经元特异性烯醇化酶(NSE)、S100β水平均上升,且观察组上升幅度低于对照组(P <0. 05);观察组疼痛分级为0级的占比、警觉/镇静(OAA/S)评分为3分的占比高于对照组,4分、5分的占比低于对照组(P <0. 05);观察组术后清醒时间、ICU住院时间、总住院时间均短于对照组(P <0. 05)。结论心脏手术中应用超快通道麻醉镇痛、镇静效果肯定,可减少术中血流动力学波动,减轻手术对患者心肌的刺激,同时可减轻机体炎症刺激,缩短住院时间,促进术后恢复。

Objective To investigate the application value of ultra-fast track anesthesia in patients undergoing cardiac surgery and its effect on the levels of serum inflammatory factors. Methods Totally 200 patients undergoing cardiac surgery in the hospital from March2013 to April 2017 were selected prospectively and randomly divided into the control group and the observation group by the random number table method,100 cases in each group. The control group was given routine anesthesia,while the observation group was given ultra-fast track anesthesia. Results Before induction of anesthesia（ T0）,there was no significant difference between the two groups in the heart rate（ HR）,mean arterial pressure（ MAP）,central venous pressure（ CVP） and cardiac troponin I（ cTnI）（ P〈0. 05）. After extracorporeal circulation（ T2）,the HR and MAP of the two groups were increased,while the CVP was decreased（ P〈0. 05） the HR and MAP of the two groups were increased at the end of operation（ T3）. From tracheal intubation T1 to T3,the c TnI in the two groups were increased,and the increase range in the observation group was lower than that in the control group（ P〈0. 05）. 1 d after surgery,the inflammation indexes in the two groups were increased,and those in the observation group were lower than those in the control group（ P〈0. 05）. 1 d after surgery,the levels of neuron specific enolase（ NSE） and S100β were increased in the two groups,and the increase range the observation group was lower than that in the control group（ P〈0. 05）. The proportions of grade 0 pain and the proportion of OAA/S score of 3 points in the observation group were higher than those in the control group,while the proportions of 4 points and 5 points were lower than those in the control group（ P〈0. 05）. The postoperative waking time,length of stay in ICU and total length of stay in the observation group were shorter than those of the control group（ P〈0. 05）. Conclusion The analgesic and sedative effects of ultra-fast track anesthesia is certain in cardiac surgery. Ultra-fast track anesthesia can reduce the hemodynamic fluctuation during surgery,alleviate the stimulation to myocardium,relieve inflammatory stimulation,shorten the length of stay and promote the postoperative recovery of patients.