丙泊酚联合盐酸羟考酮对颅脑创伤急诊手术患者的麻醉效果及相关蛋白表达的影响

Effect of propofol combined with oxycodone hydrochloride on anesthesia effect and related protein expression in patients undergoing emergency craniocerebral trauma surgery

目的探讨丙泊酚联合盐酸羟考酮在颅脑创伤急诊手术中的麻醉镇痛效果及其对髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)、S-100B蛋白、D-二聚体(D-D)及C反应蛋白(CRP)表达水平的影响。方法前瞻性选取于2017年1月至2018年12月因急性颅脑损伤在北海市第二人民医院行急诊开颅手术治疗的患者96例作为研究对象,按照随机数字法随机分为观察组(n=48)和对照组(n=48)。麻醉维持:对照组给予丙泊酚4~8 mg/(kg·h),瑞芬太尼0.1~0.15μg/(kg·min),观察组给予丙泊酚4~8 mg/(kg·h),盐酸羟考酮0.1~0.15 mg/(kg·h)。预痛处理:手术结束前15 min,对照组予舒芬太尼0.15μg/kg预先镇痛,观察组予盐酸羟考酮0.08 mg/kg预先镇痛。比较分析两组麻醉效果、镇痛效果、MBP、NSE、S-100B、D-D、CRP表达水平的差异。结果观察组的麻醉术后恢复时间、开眼时间、拔管时间均短于对照组,差异有统计学意义(P <0.05);观察组术中MAP及HR低于对对照组,差异有统计学意义(P <0.05);观察组术后1 h、6 h、12 h、24 h的视觉模拟评分(VAS)低于对照组,差异均有统计学意义(P <0.05);观察组在T1、T2时血清MBP、NSE、S-100B、D-D、CRP水平低于对照组,差异有统计学意义(P <0.05)。结论丙泊酚联合羟考酮用于急性颅脑外伤手术的麻醉维持阶段,具有较好的麻醉效果。在预镇痛处理时应用羟考酮可较好管理术后疼痛,降低疼痛引起脑组织氧化应激反应及炎症反应,减少脑组织的二次损伤,为急性脑损伤手术麻醉及镇痛处理提供新思路。

Objective To investigate the analgesic effect of propofol combined with oxycodone hydrochloride in emergency craniocerebral trauma surgery and its effect on the expression of MBP,NSE,S-100 B,D-D,CRP.Methods Ninety-six patients with acute craniocerebral injury who underwent emergency craniotomy in our hospital from January 2017 to December 2018 were randomly divided into observation group( n=48) and control group( n=48) according to random number method.Anesthesia maintenance: the control group was given propofol 4~8 mg/( kg·h),remifentanil 0.1~0.15 μg/(kg·min),The observation group was given propofol 4 ~ 8 mg/( kg·h) and oxycodone hydrochloride 0.1 ~ 0.15 mg/( kg·h).Pre-pain treatment: 15 min before the end of the operation,the control group was given sufentanil 0.15 μg/kg,the observation group was given oxycodone hydrochloride 0.08 mg/kg.The differences of anesthetic effect,analgesic effect,MBP,NSE,S-100 B,D-D,CRP expression between the two groups were compared and analyzed.Results The recovery time,eye opening time and cupping time of the observation group were shorter than those of the control group( P < 0.05).The MAP and HR of the observation group were lower than those of the control group( P < 0.05).The VAS score of the observation group was lower than that of the control group at 1 h,6 h,12 h and 24 h after operation( P < 0.05).The serum M of the observation group at T1 and T2 had statistical significance( P < 0.05).The levels of MBP,NSE,S-100 B,D-D,CRP were lower than those of the control group( P < 0.05).Conclusion Propofol combined with oxycodone has good anesthetic effect in the maintenance stage of acute craniocerebral trauma surgery.Oxycodone can better manage the pain after operation,reduce the oxidative stress reaction of brain tissue caused by pain,reduce the secondary damage of brain tissue,and provide a new idea for anesthesia and analgesic treatment of acute brain injury.