地佐辛预处理对小儿全麻手术苏醒期躁动及相关内环境变化的影响

摘要

目的:研究地佐辛预处理对小儿全麻手术苏醒期躁动及相关内环境变化的影响.方法:选择2015年1月到2017年12月期间在孝感市中心医院接受全麻手术的小儿患者200例纳入研究,采用随机数表将其分为两组,地佐辛组接受常规全身麻醉及手术结束前30分钟时地佐辛静脉推注、对照组接受常规全身麻醉及手术结束前30分钟时生理盐水静脉推注.在麻醉苏醒期时,进行苏醒期躁动的CHEPOS评分;在麻醉诱导前及苏醒期时,测定血清中炎症应激介质的含量及外周血中应激信号分子、炎症信号分子的表达量.结果:地佐辛组在麻醉苏醒期时的CHEPOS评分低于对照组;与组内麻醉诱导前比较,两组患儿苏醒期时血清中 ACTH 、Cor 、INS 、ICAM1 、TNF-α的含量以及外周血中CHOP 、GRP78 、JNK 、c-jun 、CD14 、SR的表达强度均显著升高,IRS-1 、IRS-2 、PKB的表达强度均显著降低且地佐辛组患儿苏醒期时血清中 ACTH 、Cor 、INS 、ICAM1 、TNF-α的含量以及外周血中CHOP 、GRP78 、JNK 、c-jun 、CD14 、SR的表达强度均显著低于对照组,IRS-1 、IRS-2 、PKB的表达强度均显著高于对照组.结论:地佐辛预处理对小儿全麻手术苏醒期躁动及相关内环境变化均具有改善作用.%Objective :To study the effect of dezocine pretreatment on the emergence agitation and related internal envi-ronment changes in children with general anesthesia surgery .Methods :A total of 200 children who underwent general anesthe-sia surgery in the Central Hospital of Xiaogan between January 2015 and December 2017 were enrolled in the study and divided into two groups by random number table method ,dezocine group received routine general anesthesia and intravenous injection of dezocine 30 min before the end of surgery ,and control group received routine general anesthesia and intravenous injection of saline 30 min before the end of surgery .The CHEPOS score of emergence agitation was performed during anesthesia recovery ;the levels of inflammatory stress mediators in serum as well as the expression of stress signal molecules and inflammatory sig-nal molecules in peripheral blood were measured before anesthesia induction and during anesthesia recovery .Results :The CHE-POS score of emergence agitation of dezocine group was lower than that of control group ;compared with those of same group before anesthesia induction ,serum ACTH ,Cor ,INS ,ICAM1 and TNF-α levels as well as peripheral blood CHOP ,GRP78 , JNK ,c-jun ,CD14 and SR expression intensity of both groups of patients were significantly higher whereas IRS-1 ,IRS-2 and PKB expression intensity were significantly lower during anesthesia recovery ,and serum ACTH ,Cor ,INS ,ICAM1 and TNF-α levels as well as peripheral blood CHOP ,GRP78 ,JNK ,c-jun ,CD14 and SR expression intensity of dezocine group during anesthesia recovery were significantly lower than those of control group whereas IRS-1 ,IRS-2 and PKB expression intensity were significantly higher than those of control group .Conclusion :Dezocine pretreatment has improving effect on the emergence agitation and related internal environment changes in children with general anesthesia surgery .