七氟烷及神经阻滞在上肢手术中临床效果观察

Clinical Effect of Sevoflurane and Nerve Block in Upper Limb Surgery

目的观察七氟烷及神经阻滞在上肢手术中的临床效果。方法收集成人择期上肢手术患者60例,随机分为SEV(七氟烷全麻联合臂丛神经阻滞)组和CON(静脉全麻联合臂丛神经阻滞)组各30例。SEV组臂丛神经阻滞成功后行七氟烷全身麻醉,CON组静脉注射丙泊酚。比较麻醉前、松止血带1、5、30、60min患侧肘部静脉血IL-1β(炎症因子白介素-1β)、IMA(缺血修饰白蛋白)、iNOS(诱导型一氧化氮合酶)。结果SEV组T2、T3时IL-1β、IMA、iNOS的分泌显著低于CON组(P<0.05),T4时两组IL-1β、IMA组间差异无统计学意义(P>0.05),iNOS的分泌量组间差异有统计学意义(P<0.05)。结论七氟烷可减轻上肢手术止血带反应,可能与减少炎性因子IL-1β和缺血相关因子IMA和iNOS表达有关。

Objective To observe the clinical effect of sevoflurane and nerve block in upper limb surgery.Methods 60 adult patients undergoing elective upper limb surgery were randomly divided into SEV(sevoflurane general anesthesia combined with brachial plexus block)group and CON(venous general anesthesia combined with brachial plexus block)group,30 cases each.Sevoflurane general anesthesia was performed after successful brachial plexus block in SEV group and propofol was injected intravenously in CON group.The levels of IL-1beta(inflammatory factor IL-1beta),IMA(ischemia modified albumin)and iNOS(inducible nitric oxide synthase)in venous blood of the affected elbow were compared before anesthesia,1,5,30 and 60 minutes after tourniquet release.Results The secretion of IL-1beta,IMA and iNOS at T2 and T3 in SEV group was significantly lower than that in CON group(P<0.05).There was no significant difference between IL-1beta and IMA groups at T4(P>0.05).The secretion of iNOS in SEV group was significantly lower than that in CON group(P<0.05).Conclusion Sevoflurane can alleviate the tourniquet reaction in upper limb surgery,which may be related to the decrease of the expression of inflammatory factors IL-1beta and ischemia-related factors IMA and iNOS.