患者围术期血清降钙素基因相关肽浓度变化的危险因素分析

Analysis of risk factors of perioperative blood calcitonin gene-related peptide change in patients

目的探索患者围术期血清降钙素基因相关肽(CGRP)浓度变化的麻醉相关危险因素。方法对山西医科大学第二医院麻醉科2020年9月至2021年5月期间行气管插管静脉全麻的100例患者进行前瞻性研究,收集性别、年龄、体重、美国麻醉医师协会(ASA)分级、用药时长、舒芬太尼,瑞芬太尼及丙泊酚用药总量以及用药速率等数据,对可能影响围术期血清CGRP浓度变化的因素行单因素分析,筛选具有统计学意义指标后行Logistic回归分析影响围术期血清CGRP浓度变化独立因素。结果100例患者中位年龄50岁(22~75岁),术后CGRP水平较术前比较,63例升高,37例降低。单因素分析显示性别、ASA分级、瑞芬太尼用药速率与围术期血清CGRP浓度变化明显相关(χ^(2)=4.285,χ^(2)=4.240,F=4.475,P<0.05),升高组瑞芬太尼用药速率高于降低组[(0.1669±0.0356)μg/(kg·min)比0.1492±0.0295)μg/(kg·min)]。多因素Logistic回归分析显示,手术麻醉中瑞芬太尼用药速率[优势比(OR)=1.117,95%可信区间(CI)为1.003~1.244,Waldχ^(2)=4.073,P<0.05]是围术期血清CGRP浓度变化的独立危险因素。结论手术麻醉中中瑞芬太尼用药速率是围术期血清CGRP水平降低的独立危险因素。

Objective To investigate the risk factors associated with perioperative blood calcitonin gene-related peptide(CGRP)changes in patients.Methods A prospective study was conducted on 100 patients undergoing total intravenous general anesthesia in the Department of Anesthesiology of the Second Hospital of Shanxi Medical University from September 2020 to May 2021.The data of gender,age,body weight,ASA grade,medication duration,dosage of sufentanil,remifentanil and propofol and velocity of the delivery of the drugs were collected.The factors that may affect the change of perioperative blood CGRP level were analyzed and screened,followed by Logistic analysis to access the independent factors related to outcome of the data.Results The postoperative serum CGRP levels were increased in 63 patients but decreased in 37 patients,compared with that before the induction of anesthesia,in the patients with a median age of 50 years(22-75 years).Univariate analysis showed that gender,ASA grade and velocity of use of remifentanil were correlated with the changes of perioperative blood CGRP level(χ^(2)=4.285,χ^(2)=4.240,F=4.475,P<0.05).The velocity of use of remifentanil in the increase group was higher than that in the decrease group[(0.1669±0.0356)μg/(kg·min)to(0.1492±0.0295)μg/(kg·min)].Multivariate logistic regression analysis showed that only the velocity of intravenous infusion of remifentanil was an independent risk factor for the change of perioperative blood CGRP level[odds ratio(OR)=1.117,95%confidence interval(CI):1.003-1.244,Waldχ^(2)=4.073,P<0.05].Conclusion The velocity of intravenous infusion of remifentanil is an independent risk factor for the decrease of perioperative serum CGRP.