本文選題：控制性降壓 + RAAS系統(tǒng)　； 參考：《川北醫(yī)學院》2017年碩士論文

【摘要】：目的:比較肝葉切除手術(shù)中采用瑞芬太尼控制性降壓與硝普鈉控制性降壓對病人心率、血壓、腎素-血管緊張素Ⅱ-醛固酮系統(tǒng)、CD3+T細胞、CD4+T細胞、CD8+T細胞、NK細胞、IL-2、IL-6和TNF-α的影響,評價兩者的免疫抑制作用。方法:42例擇期行肝葉切除術(shù)的患者,ASAⅠ-Ⅱ級,隨機分為3組:瑞芬太尼控制性降壓組(R組)、硝普鈉控制性降壓組(N組)和生理鹽水空白對照組(C組),分別于麻醉誘導(dǎo)前(T0)、降壓前即刻(T1)、降壓達目標血壓后10 min(T2)、30 min(T3)和停止降壓后20 min(T4)時,記錄MAP、HR,同時抽取動脈血樣用免疫發(fā)光法檢測血漿中腎素、血管緊張素Ⅱ、醛固酮含量;于麻醉前(T0)、控制性降壓后30 min(T3)、手術(shù)結(jié)束時(T5)、術(shù)后第1(T6)、第3(T7)抽取外周靜脈血測定CD3+、CD4+、CD8+、CD4+/CD8+和NK細胞的數(shù)量及IL-2、IL-6、TNF-α的濃度。結(jié)果:R組和N組均能達到很好的控制性降壓效果;(1)血流動力學方面:T2、T3時,R組MAP、HR較N組、C組明顯降低,且低于組內(nèi)各時點(P0.05),而N組HR明顯高于R組、C組及組內(nèi)各時點,C組MAP高于R組和N組,C組HR高于R組且低于N組(P0.05);T4,MAP R組和C組無明顯差異,而N組明顯高于C組和R組,且高于本組內(nèi)各時點(P0.05)。(2)RAAS系統(tǒng)方面:T2-T4,腎素、血管緊張素Ⅱ、醛固酮R組和C組無明顯統(tǒng)計學差異(P0.05),N組腎素、血管緊張素Ⅱ明顯高于組內(nèi)各時點,且高于R組和C組(P0.05);T3、T4時,N組醛固酮高于組內(nèi)T0、T1、T2且高于R組和C組(P0.05)。(3)免疫學方面:T3、T5時,R組CD3、CD8明顯低于組內(nèi)各時點(P0.05),T3時點,R組CD3、CD8明顯低于其余兩組,N組、C組TNF-a明顯高于組內(nèi)各時點且高于R組(P0.05);T5時點,N組和C組CD3、R組CD4、IL-2低于組內(nèi)各時點(P0.05),三組TNF-α明顯高于組內(nèi)各時點且N組高于其余兩組(P0.05);T6、T7時,三組IL-6均明顯高于組內(nèi)各時點,N組明顯高于其余兩組(P0.05)。結(jié)論:瑞芬太尼控制性降壓能較好的抑制RAAS系統(tǒng)的激活,減少促炎性因子IL-6、TNF-α的生成,對T淋巴細胞的抑制作用較弱,抑制效果可在術(shù)后24小時內(nèi)消除,不影響患者術(shù)后恢復(fù),較硝普鈉有更好的器官保護作用。
[Abstract]:Objective: To compare the effects of remifentanil controlled hypotension and sodium nitroprusside controlled hypotension on heart rate, blood pressure, renin angiotensin II aldosterone system, CD3+T cells, CD4+T cells, CD8+T cells, NK cells, IL-2, IL-6 and TNF- alpha in patients with hepatic lobectomy, and to evaluate the immunosuppressive effect of the 42 patients undergoing selective hepatic lobectomy The patients, ASA I - II, were randomly divided into 3 groups: Remifentanil controlled hypotension group (group R), sodium nitroprusside controlled hypotension group (group N) and normal saline blank control group (group C), before induction of anesthesia (T0), immediate (T1) before hypotension, 10 min (T2), 30 min (T3) after the target blood pressure, and 20 min (T4) after stopping blood pressure. Blood samples were used to detect plasma renin, angiotensin II, aldosterone content, before anesthesia (T0), 30 min (T3) after controlled hypotension, at the end of the operation (T5), first (T6) after operation, third (T7), and third (T7) to determine the number of CD3+, CD4+, CD8+, CD4+/CD8+ and NK cells and the concentration of IL-2. (1) hemodynamics: T2, T3, R group MAP, HR more than N group, C group obviously lower, and lower than the group time point (P0.05), N group HR obviously higher than R group, C group and the group at each time point, higher than the group and lower than the group. Significantly higher than group C and group R, and higher than the time point in the group (P0.05). (2) RAAS system aspects: T2-T4, renin, angiotensin II, aldosterone R group and C group no significant statistical difference (P0.05), N group renin, angiotensin II is significantly higher than the group of R and C group (P0.05). (3) C (P0.05). (3) immunology: T3, T5, R group CD3, CD8 obviously lower than each time point within the group (P0.05), T3 time point, R group CD3, CD8 obviously lower than the other two groups. At the time point and N group higher than the other two groups (P0.05), T6, T7, three groups of IL-6 were significantly higher than the group at all time points, N group significantly higher than the other two groups (P0.05). Conclusion: Remifentanil controlled hypotension can better inhibit the activation of RAAS system, reduce the proinflammatory factor IL-6, TNF- a, the inhibition of T lymphocyte is weak, inhibition effect can be performed in the operation. Elimination within 24 hours did not affect postoperative recovery, and had better organ protection than sodium nitroprusside.
【學位授予單位】：川北醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

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