本文選題：全身麻醉 + 圍術(shù)期　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1.觀察全身麻醉患者麻醉手術(shù)前后外周血白細(xì)胞數(shù)量及白細(xì)胞源性b-內(nèi)啡肽(b-endorphin,b-EP)和血漿b-EP、亮氨酸腦啡肽(leuthine enkephalin,LEK)含量變化。2.探討去甲腎上腺素(Noradrenaline,NE)對(duì)白細(xì)胞源性b-EP的影響。方法:1.選擇靜脈全身麻醉下行擇期手術(shù)患者48例,記錄麻醉手術(shù)前后外周血白細(xì)胞(white blood cell,WBC)總數(shù)及分類計(jì)數(shù)、百分比。于麻醉開(kāi)始前(T1)、麻醉結(jié)束患者清醒后(T2)采集肘靜脈血4 ml,流式細(xì)胞術(shù)檢測(cè)白細(xì)胞中b-EP熒光陽(yáng)性細(xì)胞百分?jǐn)?shù)和平均熒光強(qiáng)度(mean fluorescence intensity,MFI),放射免疫分析法(radioimmunoassay,RIA)測(cè)定血漿b-EP、LEK水平。2.1 ml外周血(麻醉前血樣)中加入去甲腎上腺素4μg(濃度10-5 mol/L),觀察藥物加入前(T0)、加藥即刻(T1)、30 min(T2)、1 h(T3)、2 h(T4)白細(xì)胞內(nèi)b-EP平均熒光強(qiáng)度(MFI)變化。結(jié)果:1.與麻醉開(kāi)始前相比,麻醉結(jié)束患者清醒后WBC總數(shù)、粒細(xì)胞(granulocyte,G)和單核細(xì)胞(monocyte,Mon)計(jì)數(shù)顯著增加(P0.01),淋巴細(xì)胞(lymphocyte,Lym)計(jì)數(shù)顯著降低(P0.01);中性粒細(xì)胞百分比明顯增高(P0.01),淋巴細(xì)胞百分比明顯降低(P0.01),單核細(xì)胞百分比無(wú)明顯變化。中性粒細(xì)胞與淋巴細(xì)胞比值(Neutrophil-lymphocyte ratio,NLR)明顯增高(P0.01)。麻醉手術(shù)后各類白細(xì)胞b-EP平均熒光強(qiáng)度(MFI)較術(shù)前均顯著降低(P0.05)。粒細(xì)胞含b-EP熒光陽(yáng)性細(xì)胞百分?jǐn)?shù)降低最為顯著(P0.05),淋巴細(xì)胞和單核細(xì)胞呈下降趨勢(shì)。麻醉手術(shù)后血漿b-EP、LEK水平顯著下降(P0.01)。2.離體外周血加入去甲腎上腺素,作用30 min時(shí),粒細(xì)胞、單核細(xì)胞和淋巴細(xì)胞內(nèi)b-EP平均熒光強(qiáng)度(MFI)呈增高趨勢(shì);隨著作用時(shí)間延長(zhǎng),b-EP平均熒光強(qiáng)度又逐漸降低,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.手術(shù)麻醉后患者外周白細(xì)胞數(shù)目增加,以粒細(xì)胞為主,淋巴細(xì)胞數(shù)目降低;外周血白細(xì)胞源性及血漿內(nèi)源性阿片肽水平降低。2.去甲腎上腺素短時(shí)間作用可使白細(xì)胞內(nèi)b-EP表達(dá)呈增加趨勢(shì)。
[Abstract]:Purpose 1. To observe the changes of leucocyte count, leucine enkephalin and leucine enkephalin leucine before and after general anesthesia in patients with general anesthesia before and after operation. The changes of plasma b-EP, leucine enkephalin and leucine-enkephalin leucine (Leucine enkephalin leucine) were observed before and after anesthesia. Objective: to investigate the effect of noradrenaline (NE) on leukocyte derived b-EP. Method 1: 1. Forty-eight patients undergoing elective operation under intravenous general anesthesia were selected to record the total white blood cell count and the percentage of white white blood before and after anesthesia. Blood samples of cubital vein were collected from 4 ml of cubital vein blood before anaesthesia began. The percentage of b-EP fluorescence positive cells in leukocytes and the mean fluorescence intensity of MFI were detected by flow cytometry. Radioimmunoassay was used to detect b-EPTLEK in plasma by radioimmunoassay (radioimmunoassay). The changes of b-EP mean fluorescence intensity (MFI) in leukocytes were observed by adding noradrenaline 4 渭 g (concentration 10-5 mol / L ~ (-1) into peripheral blood (blood sample before anesthesia). The result is 1: 1. Compared with before anaesthesia, the total number of WBC after anaesthesia ended, The count of granulocyteteg (GN) and monocyte (monocyte) increased significantly (P 0.01), and lymphocyte (Lym) decreased significantly (P 0.01), while the percentage of neutrophil increased significantly (P 0.01), and the percentage of lymphocytes decreased significantly (P 0.01), but the percentage of monocytes did not change significantly. The ratio of neutrophil-lymphocyte to neutrophil-lymphocyte (NLRR) was significantly higher than that of neutrophilic lymphocyte (NLRR). The mean fluorescence intensity of b-EP in all kinds of leukocytes after anesthesia was significantly lower than that before operation (P 0.05). The percentage of b-EP positive cells in granulocytes decreased most significantly (P 0.05), and the lymphocytes and monocytes showed a decreasing trend. After anesthesia, the plasma level of b-EPL-LEK decreased significantly (P 0. 01 鹵0. 02). The mean fluorescence intensity of b-EP in granulocytes, monocytes and lymphocytes increased with the addition of norepinephrine in peripheral blood for 30 min, and decreased gradually with the prolongation of action time. But the difference was not statistically significant (P 0.05). Conclusion 1. The number of peripheral white blood cells increased, mainly granulocyte, the number of lymphocytes decreased, and the levels of peripheral leukocyte derived and plasma endogenous opioid peptide decreased. The effect of norepinephrine on the expression of b-EP in leukocytes for a short time showed an increasing trend.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614.2

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