| 唐婧英,李选发,李 娜,陈俏江,邓小华.不同麻醉深度对全麻老年手术患者应激反应、免疫功能及血清IL-1β、HMGB1水平的影响[J].,2020,(5):940-943 |
| 不同麻醉深度对全麻老年手术患者应激反应、免疫功能及血清IL-1β、HMGB1水平的影响 |
| Effects of Different Anesthesia Depth on Stress Response, Immune Function and Serum Levels of IL-1β and HMGB1 in Elderly Patients Undergoing General Anesthesia |
| 投稿时间：2019-06-25 修订日期：2019-07-21 |
| DOI：10.13241/j.cnki.pmb.2020.05.031 |
| 中文关键词: 麻醉深度 老年 应激反应 免疫功能 白介素-1?茁 高迁移率族蛋白B1 |
| 英文关键词: Shallow anesthesia Elderly Stress response Immune function Interleukin-1β High mobiliby group box 1 |
| 基金项目:海南省基础与应用基础研究计划项目（818QN319） |
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| 中文摘要: |
| 摘要 目的：探讨不同麻醉深度对全麻老年手术患者应激反应、免疫功能及血清IL-1β、HMGB1水平的影响。方法：采用随机、双盲、平行法将2015年2月至2018年2月于海南省人民医院拟行全麻手术的200例老年患者分为研究组（n=102）和对照组（n=98），研究组术中脑电双频指数（BIS）维持在50-59之间，对照组BIS维持在40-49之间。分别于麻醉诱导前（T0）、手术2h（T1）、术后24 h（T2）检测患者血清皮质醇（Cor）、促肾上腺皮质激素（ACTH）、内皮素-1（ET-1）、T淋巴细胞（CD3+、CD4+、CD8+）、NK细胞(CD3-CD16+CD56+)、血清白介素-1β（IL-1β）、高迁移率族蛋白B1（HMGB1）水平，并观察两组患者术后并发症发生情况。结果：对照组Cor水平先升高后降低，且研究组T1、T2时Cor水平低于对照组（P<0.05）；两组患者ACTH水平先升高后降低，且研究组低于对照组（P<0.05）；研究组T1、T2时ET-1水平低于T0时及对照组（P<0.05）。两组CD3+、CD4+、CD8+、CD3-CD16+CD56+水平呈逐渐下降趋势，且研究组T1、T2时各指标水平均高于对照组（P<0.05）。两组IL-1β水平均先升高后降低，研究组T1时IL-1β水平低于对照组（P<0.05），两组HMGB1水平持续上升，研究组T1、T2时HMGB1水平低于对照组（P<0.05）。两组并发症发生率比较差异无统计学意义（P>0.05），但研究组术后认知功能障碍发生率低于对照组（P<0.05）。结论：维持BIS50-59的浅度麻醉可降低老年全麻手术患者围术期应激反应水平，促进术后免疫功能恢复，降低HMGB1水平及认知功能障碍发生风险，减轻围术期炎症反应。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of different anesthesia depth on stress response, immune function and serum levels of IL-1β and HMGB1 in elderly patients undergoing general anesthesia. Methods: A randomized, double-blind and parallel method was used to divide 200 elderly patients who were planning to undergo general anesthesia in Hainan Provincial People's Hospital from February 2015 to February 2018 into the study group (n=102) and the control group (n=98). The bispectral index (BIS) of the study group was maintained at 50-59, while that of the control group was maintained at 40-49. The serum cortisol (Cor), adrenocorticotropic hormone (ACTH), endothelin-1 (ET-1), T lymphocyte (CD3+, CD4+, CD8+), NK cell (CD3-CD16+CD56+), interleukin-1β (IL-1β), and high mobility group protein B1 (HMG-B1) were measured before anesthesia induction (T0), 2h after operation (T1) and 24h after operation (T2). The postoperative complications of the two groups were observed. Results: The level of Cor in the control group was increased first and then decreased, and the level of Cor at T1 and T2 in the study group were lower than those in the control group (P<0.05). The level of ACTH in the two groups was increased first and then decreased, and the study group was lower than that in the control group (P<0.05). The level of ET-1 in the study group at T1 and T2 were lower than those at T0 and the control group (P<0.05). The levels of CD3+, CD4+, CD8+, CD3-CD16+CD56+ were decreased gradually in the two groups, and the levels of each index in the study group at T1 and T2 were higher than those in the control group (P<0.05). The levels of IL-1β in both groups were increased first and then decreased, the study group at T1 was lower than that in the control group (P<0.05). The level of HMGB1 in the two groups were continued to rise, while the HMGB1 level in the study group at T1 and T2 were lower than those in the control group (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05), but the incidence of postoperative cognitive impairment in the study group was lower than that in the control group (P<0.05). Conclusion: Maintaining BIS50-59 shallow anesthesia can reduce perioperative stress response in elderly patients undergoing general anesthesia, it can promote the recovery of immune function after operation, it can reduce the level of HMGB1 and the risk of cognitive dysfunction, and it can reduce perioperative inflammatory response. |
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