本文選題：七氟醚　切入點(diǎn)：異氟醚　出處：《吉林大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：本文旨在通過觀察顱內(nèi)腫瘤患者在圍術(shù)期應(yīng)用七氟醚、異氟醚吸入麻醉時(shí)患者血漿炎性因子的差異，從而比較七氟醚與異氟醚對(duì)顱內(nèi)腫瘤患者術(shù)后抗感染能力的影響，進(jìn)而在細(xì)胞因子水平上反應(yīng)其對(duì)機(jī)體免疫功能的影響，為顱內(nèi)腫瘤患者臨床麻醉選擇用藥提供依據(jù)。 方法：本實(shí)驗(yàn)選擇擇期顱內(nèi)幕上腫瘤切除術(shù)患者30例，男、女各15例，年齡從30歲－65歲之間不等，ASA分級(jí)均為I-II級(jí)，所有患者隨機(jī)分為兩組，分別為七氟醚組（SEV組）及異氟醚組（ISO組）、每組各15例。所有患者均于入手術(shù)室前半小時(shí)肌注阿托品0.5mg，入室后開放靜脈通路，常規(guī)監(jiān)測(cè)血壓、心率、血氧飽和度、MAC值等指標(biāo)。全麻誘導(dǎo)均采用咪噠唑侖0.05mg/kg、丙泊酚2mg/kg、芬太尼2-5μg/kg以及順阿0.15mg/kg進(jìn)行誘導(dǎo)插管。術(shù)中兩組患者分別吸入異氟醚及七氟醚，維持MAC值于1—2MAC之間，并間斷靜注順阿及芬太尼維持麻醉，使BIS在40—60。兩組患者均在麻醉前（T0）、手術(shù)開始后一小時(shí)（T1）、手術(shù)開始后兩小時(shí)（T2）術(shù)畢（T3）、術(shù)后24h(T4)采外周靜脈血2ml，高速低溫離心機(jī)離心10分鐘（2000r/min），然后取上清液0.5-1.0ml（血漿）置入EP管中，于-80°C低溫冰箱中統(tǒng)一保存，最后集中以ELISA法測(cè)定血漿中TNF-α、IL-6及CRP的濃度。 結(jié)果： 1、血漿TNF-α濃度的變化： 血漿TNF-α組內(nèi)比較：ISO組TNF-α的含量,在T1與T0時(shí)間點(diǎn)相比無明顯差異（P0.05），在T2、T3時(shí)間點(diǎn)明顯升高(與T0時(shí)間點(diǎn)相比較，P＜0.05), T4時(shí)間點(diǎn)較前降低但仍明顯高于T0時(shí)間點(diǎn)(P＜0.05)。SEV組T1時(shí)間點(diǎn)與T0時(shí)間點(diǎn)比較血漿中的TNF-a顯著升高(P＜0.05)，T2、T3、T4逐漸降低，但仍高于T0時(shí)間點(diǎn)(P＜0.05)。 組間比較：在T3時(shí)間點(diǎn)ISO組TNF-α濃度高于SEV組(P0.05). 2、血漿IL-6濃度的變化： 組內(nèi)比較：在T1、T2、T3時(shí)間點(diǎn)SEV及ISO兩組患者血漿中的IL-6含量較T0時(shí)間點(diǎn)均顯著升高（P0.05），在T4時(shí)間點(diǎn)逐漸下降，略高于T0水平，但無統(tǒng)計(jì)學(xué)意義（P0.05）。 組間比較：在T3時(shí)間點(diǎn)SEV組血漿IL-6濃度低于ISO組（P0.05）。 3、血漿CRP濃度的變化： 組內(nèi)比較：在T1時(shí)間點(diǎn)兩組患者血漿中CRP的含量，較T0時(shí)間點(diǎn)均無顯著差異（P0.05），其后逐漸升高,至T3時(shí)間點(diǎn)達(dá)到峰值（P0.05），于T4時(shí)間點(diǎn)時(shí)均回降至T0水平（P0.05）。 組間比較：T3時(shí)間點(diǎn)，兩組患者血漿IL-6的濃度SEV組低于ISO組（P0.05）。 結(jié)論： 1、顱內(nèi)腫瘤患者應(yīng)用七氟醚及異氟醚均可抑制促炎性細(xì)胞因子TNF-α、IL-6以及炎癥介質(zhì)CRP的產(chǎn)生。對(duì)腫瘤患者的免疫功能的恢復(fù)具有積極意義。 2、七氟醚較異氟醚能更好的抑制顱內(nèi)腫瘤患者術(shù)中血漿促炎性細(xì)胞因子IL-6及炎癥介質(zhì)CRP的分泌、對(duì)TNF-α的抑制作用較異氟醚更小而且短暫，，在麻醉的選擇上更具優(yōu)勢(shì)。
[Abstract]:Objective: to compare the effect of sevoflurane and isoflurane on postoperative anti-infective ability of intracranial tumor patients by observing the difference of plasma inflammatory factors in patients with intracranial tumor during perioperative application of sevoflurane and isoflurane inhalation anesthesia. Furthermore, the effect of cytokines on immune function of patients with intracranial tumors was studied, which provided basis for clinical anesthetic choice in patients with intracranial tumors. Methods: 30 patients (15 males and 15 females) with selective resection of intracranial supratentorial tumors were randomly divided into two groups, with ASA grades ranging from 30 to 65 years old. There were 15 cases in each group. All the patients were injected atropine 0.5 mg half an hour before the operating room. The venous pathway was opened and blood pressure and heart rate were monitored by routine method. General anesthesia induction was performed with midazolam 0.05 mg / kg, propofol 2 mg / kg, fentanyl 2-5 渭 g / kg and cis-0.15 mg / kg respectively. Isoflurane and sevoflurane were inhaled in both groups, and the MAC values were maintained between 1 and 2 MAC. The anesthesia was maintained by intermittent intravenous injection of Sino and fentanyl. BIS was given at 40-600.The patients in both groups were treated with T0 before anesthesia, one hour after operation, one hour after operation, two hours after operation, and two hours after operation. After operation, 2 ml of peripheral venous blood was collected, 24 h after operation, 2 ml of peripheral venous blood was collected, centrifuged by high speed hypothermia centrifuge for 10 minutes, then the supernatant was taken from 0.5 to 1.0 ml (plasma) and placed into EP tube. The concentration of TNF- 偽 IL-6 and CRP in plasma was determined by ELISA method. Results:. 1. The change of plasma TNF- 偽 concentration:. The content of TNF- 偽 in the plasma TNF- 偽 group was compared with that in the control group. There was no significant difference between T 1 and T 0 time points (P 0.05), but there was a significant increase in T 2 T 3 time point (P < 0 05), and a significant decrease in T 4 time point but still higher than that in T 0 time point P < 0.05).SEV group T 1 time point and T 0 time point group compared with T 0 time point P < T 0 time point, the plasma TNF-a in T 1 time point was significantly higher than that in T 0 time point P < T 0 time point P < T 0 time point. The increase of T2T3T4 decreased gradually, P < 0.05, and the level of T3T4 decreased gradually, while that of T2T3T4 decreased gradually. But it was still higher than that of T0 (P < 0.05). Comparison between groups: at T3 time point, the concentration of TNF- 偽 in ISO group was higher than that in SEV group (P 0.05). 2. The change of plasma IL-6 concentration:. Intragroup comparison: the plasma IL-6 levels in SEV and ISO groups were significantly higher than those at T0 time point, and gradually decreased at T4 time point, slightly higher than T0 level, but had no statistical significance. Comparison between groups: at T3 time point, plasma IL-6 concentration in SEV group was lower than that in ISO group (P 0.05). 3. The change of plasma CRP concentration:. Intra group comparison: there was no significant difference in plasma CRP content between the two groups at T1 time point compared with that at T0 time point, then it increased gradually, and reached the peak value at T3 time point, and then decreased to T0 level P0.05a at T4 time point. The plasma IL-6 concentration in the two groups was lower than that in the ISO group (P 0.05). Conclusion:. 1. Both sevoflurane and isoflurane could inhibit the production of TNF- 偽 IL-6 and inflammatory mediator CRP in patients with intracranial tumors. Compared with isoflurane, sevoflurane could inhibit the secretion of plasma pro-inflammatory cytokine (IL-6) and inflammatory mediators (CRP) in intracranial tumor patients. The inhibitory effect of sevoflurane on TNF- 偽 was smaller and shorter than that of isoflurane.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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