丙泊酚对重型颅脑损伤手术患者血流动力学、术后镇痛镇静效果及血清hs-CRP、PCT、IL-22表达的影响

Effects of Propofol on Hemodynamics,Postoperative Effectiveness of Analgesia and Sedation and Expressions of Serum hs-CRP,PCT and IL-22 in Postoperative Patients with Severe Craniocerebral Injury

目的探讨丙泊酚对重型颅脑损伤(SBI)患者血流动力学、术后镇痛镇静效果及血清超敏C反应蛋白(hs-CRP)、降钙素原(PCT)及白细胞介素22(IL-22)表达的影响。方法选取2016年2月—2017年2月于我院行开颅术的SBI患者96例为研究对象,按麻醉诱导用药分为观察组与对照组,每组48例,观察组采用丙泊酚进行麻醉诱导,对照组选用依托咪酯进行麻醉诱导,观察2组麻醉诱导前(T1)、麻醉诱导后(T2)、硬脑膜切开后(T3)、手术结束(T4)、术后1 h(T5)的颅内压(ICP)、脑氧分压(PbrO_2)、血流动力学变化情况,比较2组超氧化物歧化酶(SOD)、丙二醛(MDA)、谷氨酸(Glu)、血清hs-CRP、PCT、IL-22水平。比较2组术后镇痛镇静效果及苏醒期不良反应发生情况。结果 T3、T4、T5时间点,观察组ICP水平显著低于对照组(P <0. 05),T2、T3、T4、T5时观察组PbrO_2显著高于对照组(P <0. 05); T4、T5时观察组SOD水平高于对照组(P <0. 05),MDA、Glu水平低于对照组(P <0. 05); T3、T4、T5时,观察组血清hs-CRP、PCT、IL-22水平低于对照组(P <0. 05);观察组HR与MAP各个时间点差异比较无统计学意义(P> 0. 05);对照组T3、T5时HR和MAP值高于T1、T2、T4时,且对照组高于观察组(P <0. 05)。2组总不良反应发生率比较差异无统计学意义(P> 0. 05)。观察组视觉模拟评分低于对照组(P <0. 05)。结论丙泊酚可通过降低SBI术中氧化应激反应及炎症反应进而发挥脑保护作用,同时还可稳定患者血流动力学,发挥术后镇痛镇静作用。

Objective To investigate effects of Propofol on hemodynamics,postoperative effectiveness of analgesia and sedation and expressions of serum high sensitivity C reactive protein(hs-CRP),procalcitonin(PCT)and interleukin-22(IL-22)in patients with severe craniocerebral injury(SBI).Methods A total of 96 SBI patients undergoing craniotomy during February 2016 and February 2017 were divided into observation group and control group(n=48 in each group)according to anesthesia induction medications.Observation group was given Propofol anesthesia induction,while control group was treated with Etomidate anesthesia induction.In two groups,changes of intracranial pressure(ICP),cerebral oxygen partial pressure(PbrO 2)and hemodynamics were observed before anesthesia induction(T1),after anesthesia induction(T2),after dural incision(T3),at the end of operation(T4)and at the 1 st h after operation(T5),and levels of superoxide dismutase(SOD),malondialdehyde(MDA),glutamic acid(Glu)and serum hs-CRP,PCT and IL-22 were compared.Postoperative effectiveness of analgesia and sedation and incidence rate of adverse reactions during analepsia stage were also compared in two groups.Results At T3,T4 and T5,ICP levels in observation group were significantly lower than those in control group(P<0.05).At T2,T3,T4 and T5,PbrO2 levels in observation group were significantly higher than those in control group(P<0.05).At T4 and T5 in observation group,SOD levels were significantly higher(P<0.05),while MDA and Glu levels were significantly lower than those in control group(P<0.05).At T3,T4 and T5,serum hs-CRP,PCT and IL-22 levels in observation group were significantly lower than those in control group(P<0.05).There were no significant differences in HR and MAP levels at different time points in observation group(P >0.05).At T3 and T5,HR and MAP levels were significantly higher than those at T1,T2 and T4 in control group,and the levels in control group were significantly higher than those in observation group(P<0.05).There was no significant difference in incidence rate of total adverse reactions between two groups(P >0.05).Score of visual analogue scales(VAS)in observation group was significantly lower than that in control group(P<0.05).Conclusion Propofol may protect brain by reducing oxidative stress and inflammation reactions during operation for SBI,stabilize hemodynamics and exert postoperative analgesia and sedation effectiveness.