| 122 | 8 | 51 |
| 下载次数 | 被引频次 | 阅读次数 |
为了探讨依托咪酯全凭静脉麻醉对老年骨科手术患者围术期T淋巴细胞亚群水平的影响。本研究选取2015年6月至2016年6月在本院骨科收治的65岁以上老年患者59例作为研究对象,随机分为两组,对照组30例,采用丙泊酚进行麻醉;实验组29例,采用依托咪酯。记录患者术中情况及术后不良反应,并于麻醉前30 min(T0)、手术结束后30 min(T1)及术后24 h(T2)采用流式细胞仪检测患者外周血中T淋巴细胞亚群(CD3+,CD4+,CD8+及CD4+/CD8+)的变化。结果显示,两组患者术后麻醉时间、手术时间、失血量及术后不良反应发生率均无统计学差异(p>0.05)。与T0时比较,T1时实验组和对照组的CD3+、CD4+、CD8+及CD4+/CD8+均显著降低(p<0.05),但两组之间比较差异无统计学意义(p>0.05);T2时实验组CD3+、CD4+、及CD4+/CD8+均显著高于对照组(p<0.05),两组间CD8+比较差异无统计学意义(p>0.05)。依托咪酯全凭静脉麻醉能够部分减轻老年骨科患者术后免疫抑制程度,且术后患者恢复较快。
Abstract：To investigate the effect of etomidate total intravenous anesthesia on perioperative T-lymphocyte subsets in elderly patients undergoing orthopedic surgery. In this study, 59 patients aged 65 years or older who were treated in orthopaedics at our hospital from June 2015 to June 2016 were selected as study subjects. They were randomly divided into two groups. The control group consisted of 30 patients and received propofol for anesthesia. The experimental group consisted of 29 patients and received etomidate. The patient's intraoperative conditions and postoperative adverse reactions were recorded. T lymphocytes subpopulations in peripheral blood(CD3+, CD4+, CD8+, and CD4+/CD8+) were measured by flow cytometry 30 minutes before anesthesia(T0), 30 minutes after the end of surgery(T1), and 24 hours after surgery(T2). The results showed that there was no significant difference in postoperative anesthesia time, operation time, blood loss, and postoperative adverse reactions between the two groups(p>0.05). Compared with T0, the levels of CD3+, CD4+, CD8+, and CD4+/CD8~+in experimental group and control group were significantly decreased at T1(p<0.05), but there was no significant difference between the two groups(p>0.05); The levels of CD3+, CD4+, and CD4+/CD8~+in the experimental group were significantly higher than those in the control group at T2(p<0.05), but there was no significant difference in CD8~+between the two groups(p>0.05). Etomidate total intravenous anesthesia partially reduced the degree of postoperative immunosuppression in elderly orthopaedic patients, and patients recovered faster after surgery.
Aggarwa l S.,Goyal V.K.,Chaturvedi S.K.,Mathur V.,Baj B.,and Kumar A.,2016,A comparative study between propofol and etomidate in patients under general anesthesia,Rev.Bras.Anestesiol.,60(3):237-241
Archambault P.,Dionne C.E.,Lortie G.,Le Blanc F.,Rioux A.,and Larouche G.,2012,Adrenal inhibition following a single dose of etomidate in intubated traumatic brain injury victims,CJEM.,14(5):270-282
Austin J.,and Parke T.,2009,Admixture of ephedrine to offset side effects of propofol:a randomized,controlled trial,J.Clin.Anesth.21(1):44-49
Bergen J.M.,and Smith D.C.,1997,A review of etomidate for rapid sequence intubation in the emergency department,J.Emerg.Med.15(2):221
Chiara D.C.,Dostalova Z.,Jayakar S.S.,Zhou X.,Miller K.W.,and Cohen J.B.,2012,Mapping general anesthetic binding site(s)in humanα1β3γ-aminobutyric acid type a receptors with[3h]tdbzl-etomidate,a photoreactive etomidate analogue,Biochemistry,51(4):836-847
Cuthbertson B.H.,Sprung C.L.,Annane D.,Chevret S.,Garfield M.,Goodman S.,Laterre P.F.,Vincent J.L.,Freivogel K.,Reinhart K.,Singer M.,Payen D.,and Weiss Y.G.,2009,The effects of etomidate on adrenal responsiveness and mortality in patients with septic shock,Intensive Care Med.,35(11):1868-1876
Du Y.,Chen Y.J.,He B.,and Wang Y.W.,2015,The effects of single-dose etomidate versus propofol on cortisol levels in pediatric patients undergoing urologic surgery:a randomized controlled trial,Anesth.Analg.,121(6):1580-1585
Gu W.J.,Wang F.,Tang L.,and Liu J.C.,2015,Single-dose etomidate does not increase mortality in patients with sepsis:a systematic review and meta-analysis of randomized controlled trials and observational studies,Chest,147(2):335-346
Han N.H.,Wu W.F.,and Jia B.H.,2013,Effect of Etomidate intravenous anesthetic on serum cortisol and postoperative cognitive dysfunction after abdominal surgery in elderly pa tients,Zhongguo Xiandai Yixue Zazhi(China Journal of Modern Medicine),23(2):78-82(韩南火,吴慰芳,贾宝辉,2013,依托咪酯静脉麻醉对老年腹部手术患者血浆皮质醇及术后认知功能障碍的影响,中国现代医学杂志,23(2):78-82)
Hohl C.M.,Kelly-Smith C.H.,Yeung T.C.,Sweet D.D.,Doyle-Waters M.M.,and Schulzer M.,2010,The effect of a bolus dose of etomidate on cortisol levels,mortality,and health services utilization:a systematic review,Annals of E-mergency Medicine,56(2):105-113
Jabre P.,Combes X.,Lapostolle F.,Dhaouadi M.,Ricard-Hibon A.,Vivien B.,Bertrand L.,Beltramini A.,Gamand P.,Albizzati S.,Perdrizet D.,Lebail G.,Chollet-Xemard C.,Maxime V.,Brun-Buisson C.,Lefrant J.Y.,Bollaert P.E.,Megarbane B.,Ricard J.D.,Anguel N.,Vicaut E.,Adnet F.,and KE-TASED Collaborative Study Group,2009,Etomidate versus ketamine for rapid sequence intubation in acutely ill patients:a multicenter randomized controlled trial,Lancet,13(1):293-300
Jackson W.L.,2005,Should we use etomidate as an induction agent for endotracheal intubation in patients with septic shock:a critical appraisal,Chest,127(3):1031-1038
Ledingham I.M.,and Watt I.,1983,Influence of sedation on mortality in critically ill multiple trauma patients,Lancet,321(8336):1270-1270
Li D.H.,Zeng Q.G.,Ceng X.R.,and Li Y.Y.,2014,The investigation of the feasibility of etomidate total intravenous anesthesia surgery in the elderly,Linchuang He Shiyan Yixue Zazhi(Journal of Clinical and Experimental Medicine),13(16):1371-1374(黎达锋,曾秋谷,岑相如,黎瑶瑶,2014,依托咪酯全凭静脉麻醉在老年人手术中可行性的探讨,临床和实验医学杂志,13(16):1371-1374)
Ma T.T.,Hu B.W.,Zhou C.,Zhu H.D.,and Li Q.,2016,Influence of propofol and etomidate anesthesia on cellular immune function in patients with septic shock,Zhonghua Yiyuan Ganranxue Zazhi(Chinese Journal of Nosocomiology),26(12):2682-2684(马婷婷,胡兵伟,周程,朱华东,李奇,2016,感染性休克患者采用丙泊酚与依托咪酯麻醉对细胞免疫功能的影响研究,中华医院感染学杂志,26(12):2682-2684)
Mcgrath M.,Ma C.,and Raines D.,2017,Dimethoxy-etomidate:a non-hypnotic etomidate analog that potently inhibits steroidogenesis,J.Pharmacol.Exp.Ther.364(2):229-237
Sivilotti M.L.,Filbin M.R.,Murray H.E.,Slasor P.,and Walls R.M.,2003,Does the sedative agent facilitate emergency rapid sequence intubation?Acad.Emerg.Med.,10(6):612-620
Sokolove P.E.,Price D.D.,and Okada P.,2000,The safety of etomidate for emergency rapid sequence intubation of pediatric patients,Pediatr.Emerg.Care 16(1):18-21
Vanlersberghe C.,and Camu F.,2008,Etomidate and other non-barbiturates,Handb.Exp.Pharmacol.,182(182):267-282
Wagner R.L.,White P.F.,Kan P.B.,Ros enthal M.H.,and Feldman D.,1984,Inhibition of adrenal steroidogenesis by the anesthetic etomidate,N.Engl.J.Med.,310(22):1415-1421
Yang B.,Ma J.Z.,and Ba G.Q.,2015,Progress in the effect of etomidate on adrenocortical function,Guoji Mazuixue Yu Fusu Zazhi(International Journal of Anesthesiology and Resuscitation),36(6):531-535(杨犇,马金芝,巴桂戚,2015,依托咪酯对肾上腺皮质功能影响的研究进展,国际麻醉学与复苏杂志,36(6):531-535)
Yang K.H.,Hu Y.,Li Y.,and Peng C.X.,2016,Two different methods of anesthesia for laparoscopic colon perioperative cellular immunity and cytokines of patients with colon cancer,Linchuang He Shiyan Yixue Zazhi(Journal of Clinical and Experimental Medicine),15(2):173-176(杨坤渹,胡颖,李扬,彭承旭,2016,不同麻醉方法对腹腔镜结肠癌根治术患者细胞免疫及细胞因子的影响,临床和实验医学杂志,15(2):173-176)
Yao L.,2015,The feasibility study of etomidate fat emulsion used for elderly patients with total intravenous anesthesia maintaining,Yixue Zongshu(Medical Recapitulate),21(18):3415-3416(姚琳,2015,依托咪酯脂肪乳用于老年患者全凭静脉麻醉维持的可行性研究,医学综述,21(18):3415-3416)
Yin G.P.,Zhuo J.W.,and Wang J.,2014,Effects of intravenous and combined anesthesia on the immune function in surgical patients with hepatic cirrhosis,Linchuang Mazuix ue Zazhi(Journal of Clinical Anesthesiology),30(10):958-960(殷国平,卓九五,王佳,2014,静-吸复合麻醉和全凭静脉麻醉对肝炎肝硬化患者围术期免疫功能的影响,临床麻醉学杂志,30(10):958-960)
Yu J.,Jiang K.,Wu S.Y.,and Wang A.M.,2013,Risk factors for perioperative complications in orthopedic aged patients,Disan Junyidaxue Xuebao(Acta Academiae Medicinae Militaris Tertiae),35(11):1160-1163(余江,蒋科,吴思宇,王爱民,2013,骨科老年患者围手术期并发症相关危险因素评估,第三军医大学学报,35(11):1160-1163)
Zed P.J.,Abu-Laban R.B.,and Harrison D.W.,2006,Intubating conditions and hemodynamic effects of etomidate for rapid sequence intubation in the emergency department:an observational cohort study,Acad.Emerg.Med.,13(4):378
基本信息:
DOI：10.13417/j.gab.037.004141
中图分类号:R614
引用信息:
[1]柴林,刘智慧,甘建辉,等.依托咪酯全凭静脉麻醉对老年骨科手术患者围术期T淋巴细胞亚群水平的影响[J].基因组学与应用生物学,2018,37(09):4141-4147.DOI:10.13417/j.gab.037.004141.
基金信息:
河北省唐山市人民医院资助
2018-09-20
2018-09-20