咪达唑仑、丙泊酚和依托咪酯用于无痛胃镜检查对患者炎症应激、血流动力学的影响

Effects of midazolam,propofol and etomidate on inflammatory stress and hemodynamics in patients with painless gastroscopy

目的探讨咪达唑仑、丙泊酚和依托咪酯用于无痛胃镜检查对患者炎症应激、血流动力学的影响。方法选取2017年1月至2018年12月在宁波市鄞州人民医院行无痛胃镜检查的患者80例作为研究对象,按照随机数字表法将患者分为研究组和对照组,每组40例。对照组给予丙泊酚+咪达唑仑进行静脉麻醉,研究组给予丙泊酚+依托咪酯+咪达唑仑进行静脉麻醉。比较两组检查前后的炎性反应指标、应激反应指标、血流动力学指标。结果检查前两组肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素10(IL-10)水平差异均无统计学意义(t=0.389、0.755、0.106,均P>0.05),检查后两组TNF-α、IL-6、IL-10水平均升高(均P<0.05),且研究组TNF-α、IL-6、IL-10水平明显均低于对照组[(4.95±0.64)ng/L比(6.09±0.69)ng/L,(6.31±0.75)ng/L比(7.18±0.90)ng/L,(7.52±0.95)ng/L比(9.58±1.28)ng/L,t=7.661、4.697、8.173,均P<0.05)]。检查前两组皮质醇(Cor)、醛固酮(ALD)、去甲肾上腺素(NE)、血管紧张素Ⅱ(AT-Ⅱ)水平差异均无统计学意义(t=0.130、0.386、0.229、0.481,均P>0.05),检查后两组Cor、ALD、NE、AT-Ⅱ水平均升高(均P<0.05),且研究组Cor、ALD、NE、AT-Ⅱ水平均明显低于对照组[(227.61±25.77)nmol/L比(273.52±35.87)nmol/L,(39.89±5.60)ng/L比(50.47±5.92)ng/L,(61.33±7.63)μg/L比(73.41±8.54)μg/L,(23.58±3.07)μg/L比(30.94±4.24)μg/L,t=6.574、8.211、6.671、8.892,均P<0.05)。检查前两组心率(HR)、收缩压(SBP)、舒张压(DBP)水平比较,差异均无统计学意义(t=0.282、0.216、0.277,均P>0.05),检查后对照组HR、SBP、DBP水平均下降(均P<0.05),且研究组HR、SBP、DBP水平均明显高于对照组[(75.22±5.80)次/min比(71.79±5.77)次/min,(83.91±4.52)mmHg比(79.55±5.14)mmHg,(128.56±6.67)mmHg比(121.68±5.02)mmHg,t=2.652、4.029、5.212,均P<0.05]。结论对无痛胃镜检查患者给予丙泊酚+依托咪酯+咪达唑仑静脉麻醉,可有效减轻患者的炎性反应、应激反应,稳定血流动力学。

Objective To investigate the effects of midazolam,propofol and etomidate on inflammatory stress and hemodynamics in patients with painless gastroscopy.Methods Eighty patients who underwent painless gastroscopy in Yinzhou People's Hospital of Ningbo from January 2017 to December 2018 were enrolled.The patients were divided into study group and control group according to the random number table method,with 40 cases in each group.The control group was given propofol+midazolam intravenous anesthesia,and the study group received propofol+etomidate+midazolam for intravenous anesthesia.The inflammatory response index,stress response index and hemodynamic index were compared between the two groups before and after examination.Results There were no statistically significant differences in the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-10(IL-10)between the two groups before examination(t=0.389,0.755,0.106,all P>0.05),and the levels of TNF-α,IL-6 and IL-10 in the two groups were increased after examination(all P<0.05),and the levels of TNF-α,IL-6 and IL-10 in the study group were significantly lower than those in the control group,the differences were statistically significant[(227.61±25.77)nmol/L vs.(273.52±35.87)nmol/L,(39.89±5.60)ng/L vs.(50.47±5.92)ng/L,(61.33±7.63)μg/L vs.(73.41±8.54)μg/L,(23.58±3.07)μg/L vs.(30.94±4.24)μg/L,t=6.574,8.211,6.671,8.892,all P<0.05].There were no statistically significant differences in cortisol(Cor),aldosterone(ALD),norepinephrine(NE),and angiotensinⅡ(AT-Ⅱ)levels between the two groups before examination(t=0.130,0.386,0.229,0.481,all P>0.05),and the levels of Cor,ALD,NE and AT-Ⅱin the two groups were increased after examination(all P<0.05).The Cor,ALD,NE and AT-Ⅱlevels in the study group were significantly lower than those in the control group,and the differences were statistically significant[(227.61±25.77)nmol/L vs.(273.52±35.87)nmol/L,(39.89±5.60)ng/L vs.(50.47±5.92)ng/L,(61.33±7.63)μg/L vs.(73.41±8.54)μg/L,(23.58±3.07)μg/L vs.(30.94±4.24)μg/L,t=6.574,8.211,6.671,8.892,all P<0.05].There were no statistically significant differences in heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP)between the two groups before examination(t=0.282,0.216,0.277,all P>0.05),and the HR,SBP and DBP levels of the control group were decreased after examination(all P<0.05).The levels of HR,SBP and DBP of the study group were significantly higher than those of the control group,and the differences were statistically significant[(75.22±5.80)times/min vs.(71.79±5.77)times/min,(83.91±4.52)mmHg vs.(79.55±5.14)mmHg,(128.56±6.67)mmHg vs.(121.68±5.02)mmHg,t=2.652,4.029,5.212,all P<0.05].Conclusion Intravenous anesthesia with propofol+etomidate+midazolam in patients with painless gastroscopy can effectively reduce the inflammatory response,stress response and stabilize hemodynamics.