兰州大学机构库 >学院待认领
异丙酚在心脏瓣膜置换术中对炎症反应中性粒细胞的影响
Alternative TitleThe Effects of Propofol Pre-Conditioning On the Neutrophil in Patients Undergoing Valve Replacment during Cardiac Pulmonary Bypass
贾鹤龄
Thesis Advisor冷玉芳 ; 周丕均
2005-05-25
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Keyword二异丙酚 心肺转流术 炎症反应 中性粒细胞
Abstract背景和目的:心脏瓣膜置换术所致的术后患者全身炎症反应(systemic inflammatory response,SIR)是心脏外科工作中常见的临床问题。因手术创伤大,体外循环(Cardiopulmonary bypass, CPB)又是一种非生理性的循环方式,故由此诱发的全身炎症反应综合症(systemic inflammatory response syndrom,SIRS)是导致全身各组织器官损伤的重要原因。近年来研究表明,在急性炎症中,许多炎性介质、氧自由基等可促使中性粒细胞又称多核白细胞(PMN)凋亡减少,这就使PMN被持续激活,从而使SIR加剧。异丙酚(Propofol)具有麻醉、抗氧化、清除氧自由基和抑制中性粒细胞(PMN)的功能及致炎细胞因子的释放等作用。本试验将异丙酚用于CPB下行心脏瓣膜置换术的患者,通过观察异丙酚对致炎因子、氧自由基及PMN的影响,探讨异丙酚对PMN凋亡的影响及其对机体保护作用的机制,为心脏外科麻醉合理用药及改善患者SIR,降低手术后的并发症提供理论依据。 方法: 选择ASAⅡ~III级,主动脉阻断时间在40分钟和体外循环时间在60分钟以上的风湿性心脏瓣膜病人40例,随机分成两组,即对照组和异丙酚组(每组20例)。除异丙酚组在麻醉诱导后靶控输注异丙酚外,其它术中用药两组均相同。术中在血流动力学指标的监测下,分别于麻醉诱导后CPB前(T1)、主动脉阻断后30min(T2)、主动脉开放时(T3)、CPB停机后30min(T4)、停机后90min(T5)采集上腔静脉血检测血浆中肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、血浆丙二醛(MDA)的浓度及超氧化物歧化酶(SOD)的活性。并于T1、T4时间点采集上腔静脉血检测中性粒细胞NF-κB和Bcl-2的表达及中性粒细胞计数。统计数据用均数±标准差(x±s)表示,采用SPSS 11.5统计软件包处理,以P<0.05为显著性检验标准。
Other AbstractObjective: It is frequent clinic question to systemic inflammatory response (SIR) is induced by the valvular replacement under the Cardiopulmonary bypass (CPB) in cardiac surgery. It is important reason of tissue and organ injury that was induced by systemic inflammatory response syndrome (SIRS). But SIRS is induced because operation wounds, CPB which is not a physiological circulation. Recent studies have revealed a lot of proinflammatory cytokines , oxygen free radicals etc can reduce neutrophil apoptosis in acute inflammatory action. It makes neutrophil activated unremitting and releasing more mediators of inflammation, at the final, it will induce SIRS and release incidence rate of Post-operative complication. Propofol has been shown that it not only has the actions of anesthesia and antioxidation, but also can clear oxygen free radicals, inhibit the function of neutrophil and the release of proinflammatory cytokines etc. In this experiment, propofol was used to the patients undergone the valvular replacement under the CPB. By means of observing the effects of propofol on the proinflammatory cytokines, oxygen free radicals and the function of neutrophil in order to inquire into the significance of proinflammatory cytokines with CPB and the mechanism of propofol’s protective action, provide theoretical basis for cardiac surgery anesthesia, improve post-operative SIRS and degrade post-operative complication. Methode: Forty patients with rheumatic heart valvular disease whose ASA scale was II-III, aortic clamping time and bypass time were more than 40,60minutes (min) respectively were selected and divided randomly into two groups (n=20 each): control group and propofol group.There were no differences between two groups about medication during operation except that the propofol was used for anesthesia maintenance in propofol group. Propofol group where Propofol with blood drug level 2.5-3.4 μg ∙ ml-1 by ALARIS IVAC TIVA TCI target-controlled infusion.Under the monitoring of hemodynamics at surgery, heparinized anticoagulant blood samples from superior vena cava were taken after anesthesia induction and before CPB(T1), aortic clamping(T2), 30min after aortic clamping(T3), 30min(T4), 90min(T5) after discontinuation of CPB (T2) for determination following data:① NF-κB and Bcl-2 in neutrophil,②plasma levels of tumour necrosis factor-α(TNF-α), interleukin-8(IL-8), interleukin-10(IL-10), malondiadilyde(MDA), superoxide dismutase (SOD) activity.T...
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Language中文
Document Type学位论文
Identifierhttps://ir.lzu.edu.cn/handle/262010/222349
Collection学院待认领
Affiliation临床医学院
Recommended Citation
GB/T 7714
贾鹤龄. 异丙酚在心脏瓣膜置换术中对炎症反应中性粒细胞的影响[D]. 兰州. 兰州大学,2005.
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