本文選題：瑞芬太尼 + 迷走神經(jīng)�。� 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:通過觀察瑞芬太尼對(duì)切斷雙側(cè)迷走神經(jīng)或雙側(cè)交感神經(jīng)新西蘭兔血流動(dòng)力學(xué)及乙酰膽堿、去甲腎上腺素的影響,探討瑞芬太尼引起心率減慢、血壓降低的途徑,進(jìn)一步研究其產(chǎn)生心血管抑制效應(yīng)的機(jī)制,從而提高圍手術(shù)期的麻醉管理質(zhì)量。方法:選擇健康雄性新西蘭兔40只,體重2~2.5kg,隨機(jī)分為5組,每組8只。實(shí)驗(yàn)組分為切斷迷走神經(jīng)+瑞芬太尼組(V+R組),切斷交感神經(jīng)+瑞芬太尼組(S+R組)。對(duì)照組分為切斷迷走神經(jīng)+生理鹽水組(V組),切斷交感神經(jīng)+生理鹽水組(S組),保留迷走神經(jīng)及交感神經(jīng)+瑞芬太尼組(R組)。各組實(shí)驗(yàn)兔用1%戊巴比妥鈉全麻后,V+R組、V組行雙側(cè)迷走神經(jīng)切斷;S+R組、S組行雙側(cè)交感神經(jīng)切斷。神經(jīng)處理后,V+R組、S+R組與R組分別靜脈注射5?g/kg瑞芬太尼。記錄各組麻醉后(T0)、神經(jīng)處理后(T1)、瑞芬太尼靜脈注射30s時(shí)(T2)的心率(HR)和動(dòng)脈血壓(ABP),在各時(shí)間點(diǎn)抽取動(dòng)脈血檢測(cè)乙酰膽堿(ACh)和去甲腎上腺素(NE)含量。根據(jù)測(cè)得的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.V+R組與R組心率:V+R組T1(254.25±10.25)較R組T1(235.13±14.84)明顯增快,差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組T2比較無明顯差異(P0.05)。平均動(dòng)脈壓:兩組T0、T2變化無明顯差異(P0.05);V+R組T1(94.50±14.06)與R組T1(89.63±13.44)相比雖有小幅度升高,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。乙酰膽堿:V+R組T0(11.61±6.11)、T1(9.77±0.73)與R組相比均無明顯差異(P0.05);但R組T2(14.01±5.31)明顯高于V+R組T2(10.23±0.62),差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。去甲腎上腺素:V+R組T0(14.63±3.37)、T1(17.98±3.85)、T2(15.85±3.88)與R組相比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。2.S+R組與R組心率:S+R組T0(226.00±14.41)、T2(198.00±8.70)與R組相比較無統(tǒng)計(jì)學(xué)意義(P0.05)。僅S+R組T1(206.50±7.80)與R組在同一時(shí)間點(diǎn)相比大幅度減慢,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。平均動(dòng)脈壓:S+R組各時(shí)間點(diǎn)與R組相比均無統(tǒng)計(jì)學(xué)意義(P0.05)。乙酰膽堿:S+R組T2(17.17±0.76)與T1(12.76±0.67)、T0(12.33±1.01)相比明顯升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。S+R組T1(12.76±0.67)、T2(17.17±0.76)與R組相比顯著升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。去甲腎上腺素:S+R組T1(17.14±2.56)較T0(21.20±2.20)減少,差異有統(tǒng)計(jì)學(xué)意義(P0.05);S+R組各時(shí)間點(diǎn)與R組比較均無統(tǒng)計(jì)學(xué)意義(P0.05)。3.V+R組與V組心率:V組T1(258.88±14.72)較T0(240.63±13.28)明顯增快,差異有統(tǒng)計(jì)學(xué)意義(P0.05);T2(254.13±14.5)與T1(258.8±14.72)相比無明顯差異(P0.05)。V+R組僅T2(193.25±11.08)明顯低于V組T2(254.13±14.5)時(shí)間點(diǎn),差異具有統(tǒng)計(jì)學(xué)意義(P0.05);平均動(dòng)脈壓:V組T1(94.88±5.14)較T0(82.75±6.71)明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);T2(89.25±6.59)與T1(94.88±5.14)相比無明顯改變(P0.05)。V+R組僅有T2(74.00±3.59)明顯低于V組T2(89.25±6.59)且差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。乙酰膽堿:V+R組各時(shí)間點(diǎn)ACh含量與V組相比均無統(tǒng)計(jì)學(xué)意義(P0.05)。去甲腎上腺素:V組T1(14.36±4.77)與T0(10.59±2.52)相比較無明顯差異(P0.05);T2(19.44±2.01)較T1(14.36±4.77)升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。V+R組僅T0(14.63±3.37)明顯高于V組同時(shí)刻值,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.S+R組與S組心率:S組T1(199.50±10.39)較T0(228.88±15.07)明顯減慢,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。S+R組僅有T2(198.00±8.70)與S組T2(208.38±16.96)相比輕度減慢,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。平均動(dòng)脈壓:S組T1(68.38±6.57)較T0(75.13±7.40)有大幅度降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。S+R組僅有T2(61.00±14.49)與S組T2(70.38±4.63)相比輕度降低,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。乙酰膽堿:S組T1(12.78±0.96)較T0(11.66±0.99)增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。S+R組僅有T2(17.17±0.76)與S組T2(11.74±1.19)相比明顯增加,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。去甲腎上腺素:S+R組僅T0(21.20±2.20)與S組T0(17.30±3.50)時(shí)間點(diǎn)比較具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:瑞芬太尼可以引起切斷雙側(cè)交感神經(jīng)實(shí)驗(yàn)組心率減慢、血壓降低,且血中乙酰膽堿含量較切斷雙側(cè)交感神經(jīng)對(duì)照組升高,可推斷瑞芬太尼可通過興奮迷走神經(jīng)引起循環(huán)抑制。瑞芬太尼也可引起切斷雙側(cè)迷走神經(jīng)實(shí)驗(yàn)組心率減慢、血壓降低,但血漿去甲腎上腺素含量沒有明顯改變,可以認(rèn)為瑞芬太尼的循環(huán)抑制機(jī)制與交感神經(jīng)無關(guān)。
[Abstract]:Objective: To observe the effect of remifentanil on the vagus nerve or bilateral rabbit hemodynamics and acetylcholine, noradrenaline, on remifentanil induced heart rate, blood pressure lowering approaches, further study on the mechanism of the inhibitory effect of the cardiovascular system, so as to improve the quality of anesthesia management during perioperative period. Methods: select healthy male New Zealand 40 rabbits, weighing 2~2.5kg, were randomly divided into 5 groups, 8 rats in each group. The experimental group was divided into vagotomy + remifentanil group (V+R group), the sympathetic denervation + remifentanil group (S+R group). Control group was divided into vagotomy + saline group (V group), the sympathetic denervation + saline group (group S), vagus nerve and sympathetic nerve + remifentanil group (R group). Each group of experimental rabbit with 1% sodium pentobarbital anesthesia, group V+R, group V underwent bilateral vagotomy; group S+R, group S 鍙屼晶浜ゆ劅紲炵粡鍒囨柇.紲炵粡澶勭悊鍚，

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