依托咪酯与七氟烷分别复合骶管或硬膜外阻滞麻醉对患儿麻醉效果及炎症因子的影响

Influence of Etomidate or Sevoflurane Combined with Sacral or Epidural Block Anesthesia on Anesthesia Effects and Inflammatory Factors

目的:探讨依托咪酯与七氟烷分别联合骶管或硬膜外阻滞麻醉对患儿麻醉效果、炎症因子的影响及安全性。方法:选取我院2012年2月-2015年12月收治的拟行手术治疗的患儿160例,按随机数字表法分为A、B组,各80例。A组患儿给予依托咪酯注射液3 mg/(kg·h)维持麻醉+骶管或硬膜外阻滞;B组患儿给予七氟烷吸入1%~3%维持麻醉+骶管或硬膜外阻滞。比较两组患儿麻醉效果及手术前后血清S100β蛋白(S100β)、神经元特异性烯醇化酶(NSE)、β淀粉酶(Aβ)和炎症因子水平,并观察不良反应发生情况。结果:两组患儿手术前后血氧饱和度(Sp O2)比较,差异无统计学意义(P>0.05);A组患儿麻醉诱导时间、术后苏醒时间、心率均长于或高于B组,差异有统计学意义(P<0.05)。术前,两组患儿血清S100β、NSE、Aβ及炎症因子水平比较,差异无统计学意义(P>0.05);术后,两组患儿血清S100β、NSE、Aβ及CRP、白细胞介素(IL)-2、IL-6水平均明显升高,且A组明显高于B组,差异有统计学意义(P<0.05);肿瘤坏死因子α(TNF-α)手术前后及组间比较,差异无统计学意义(P>0.05)。两组患儿均未见明显不良反应发生。结论:七氟烷复合骶管或硬膜外阻滞麻醉效果明显优于依托咪酯复合麻醉,且炎症反应较轻、安全性较好。

OBJECTIVE:To investigate the influence and safety of etomidate or sevoflurane combined with sacral or epidural block anesthesia on anesthesia effects and inflammatory factors.METHODS:160children undergoing surgery selected from our hospital during Feb.2012to Dec.2015were divided into group A and B according to random number table,with80cases in eachgroup.Group A was given etomidate3mg/(kg·h)for anesthesia maintenance+sacral or epidural block;group B received sevoflurane inhalation1%-3%for anesthesia maintenance+sacral or epidural block.The anesthesia effects were compared between2groups as well as the levels of serum S100β,NSE,Aβand inflammatory factors before and after surgery.The occurrence of ADRwas observed.RESULTS:There was no statistical significance in SpO2between2groups before and after surgery(P>0.05).Theanesthesia induction time,postoperative recovery time and heart rate of group A were significantly longer or higher than those ofgroup B,with statistical significance(P<0.05).There was no statistical significance in the levels of serum S100β,NSE,Aβandinflammatory factors between2groups before surgery(P>0.05).After surgery,the levels of serum S100β,NSE,Aβ,CRP,IL-2and IL-6were significantly increased in2groups,and group A was significantly higher than group B,with statistical significance(P<0.05);there was no statistical significance in TNF-αbefore and after surgery or between2groups(P>0.05).No obvious ADR was found in2groups.CONCLUSIONS:Sevoflurane combined with sacral or epidural block anesthesia is better than etomidate combin ation anesthesia,with in mild inflammatory reaction and good safety.