本文選題：全身麻醉 + 圍術期�。� 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:1.觀察全身麻醉患者麻醉手術前后外周血白細胞數(shù)量及白細胞源性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)對白細胞源性b-EP的影響。方法:1.選擇靜脈全身麻醉下行擇期手術患者48例,記錄麻醉手術前后外周血白細胞(white blood cell,WBC)總數(shù)及分類計數(shù)、百分比。于麻醉開始前(T1)、麻醉結束患者清醒后(T2)采集肘靜脈血4 ml,流式細胞術檢測白細胞中b-EP熒光陽性細胞百分數(shù)和平均熒光強度(mean fluorescence intensity,MFI),放射免疫分析法(radioimmunoassay,RIA)測定血漿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)白細胞內(nèi)b-EP平均熒光強度(MFI)變化。結果:1.與麻醉開始前相比,麻醉結束患者清醒后WBC總數(shù)、粒細胞(granulocyte,G)和單核細胞(monocyte,Mon)計數(shù)顯著增加(P0.01),淋巴細胞(lymphocyte,Lym)計數(shù)顯著降低(P0.01);中性粒細胞百分比明顯增高(P0.01),淋巴細胞百分比明顯降低(P0.01),單核細胞百分比無明顯變化。中性粒細胞與淋巴細胞比值(Neutrophil-lymphocyte ratio,NLR)明顯增高(P0.01)。麻醉手術后各類白細胞b-EP平均熒光強度(MFI)較術前均顯著降低(P0.05)。粒細胞含b-EP熒光陽性細胞百分數(shù)降低最為顯著(P0.05),淋巴細胞和單核細胞呈下降趨勢。麻醉手術后血漿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,粒細胞、單核細胞和淋巴細胞內(nèi)b-EP平均熒光強度(MFI)呈增高趨勢;隨著作用時間延長,b-EP平均熒光強度又逐漸降低,但差異無統(tǒng)計學意義(P0.05)。結論:1.手術麻醉后患者外周白細胞數(shù)目增加,以粒細胞為主,淋巴細胞數(shù)目降低;外周血白細胞源性及血漿內(nèi)源性阿片肽水平降低。2.去甲腎上腺素短時間作用可使白細胞內(nèi)b-EP表達呈增加趨勢。
[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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614.2

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