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目的:观察咪达唑仑对急性颅脑损伤患者免疫功能和应激反应的影响。方法:选择急性颅脑损伤96例,随机分为观察组和对照组各48例。对照组采用利多卡因、舒芬太尼、阿曲库铵等常规诱导麻醉用药,观察组在对照组用药基础上加用咪达唑仑;观察组术后给予咪达唑仑2~4mg静脉注射,再微量泵持续输注咪达唑仑0.05mg/(kg·h);对照组给予等量生理盐水持续泵入。观察两组麻醉诱导前(T0)、手术60min(T1)、手术结束时(T2)等3个时间点的平均动脉压(MAP)、心率(HR)变化;检测外周血血清中肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、C反应蛋白(CRP)、CD4~+、CD8~+水平及CD4~+/CD8~+比值;观察两组术后外周血乳酸、血糖水平变化及手术前后凝血功能(FBG、D-二聚体、PLT、APTT及PT)变化。结果:两组T1、T2时间点MAP、HR比较,均差异非常显著(P<0.01)。两组术后第1天、第3天、第7天血清TNF-α、IL-6、IL-10水平比较,均差异显著或非常显著(P<0.05,P<0.01);两组术后第1天、第3天、第7天CRP水平比较,均差异非常显著(P<0.01);两组术后第1天、第3天、第7天CD4~+阳性率、CD8~+阳性率、CD4~+/CD8~+比值比较,均差异显著(P<0.05)。两组术后第1天、第3天、第7天外周血乳酸及血糖水平比较,均差异非常显著(P<0.01)。两组术后凝血功能变化情况比较,均差异不显著(P>0.05)。结论:咪达唑仑可有效调节急性颅脑损伤患者免疫平衡、改善应激状态,对脑组织有较好的保护作用。
Objective: To observe the effect of midazolam on immune function and stress response in patients with acute craniocerebral injury. Methods: A total of 96 acute craniocerebral injury patients were randomly divided into observation group (48 cases) and control group (48 cases). In the control group, lidocaine, sufentanil and atracurium were used to induce anesthesia. The observation group was given midazolam on the basis of the control group. The observation group was given intravenous midazolam 2 to 4 mg Injection, and then a small amount of continuous infusion of midazolam 0.05mg / (kg · h); control group given an equal volume of saline continued pumped. The changes of mean arterial pressure (MAP) and heart rate (HR) were observed before anesthesia induction (T0), operation 60min (T1), end of operation (T2) and other three time points. The levels of tumor necrosis factor alpha The levels of TNF-α, IL-6, IL-10, CRP, CD4 +, CD8 + and CD4 + / CD8 + + Ratio. Changes in postoperative peripheral blood lactate, blood glucose levels and changes in coagulation function (FBG, D-dimer, PLT, APTT and PT) were observed. Results: There were significant differences in MAP and HR between the two groups at T1 and T2 (P <0.01). The levels of TNF-α, IL-6 and IL-10 in the two groups at 1, 3 and 7 days after operation were significantly different (P <0.05, P <0.01) There were significant differences in CRP levels between the first day, the third day and the seventh day (P <0.01). On the 1st day, 3rd day and 7th day after operation, the positive rates of CD4 +, CD8 + positive Rate, CD4 ~ + / CD8 ~ + ratio, there was significant difference (P <0.05). There was significant difference (P <0.01) in the levels of lactate and blood glucose in the peripheral blood on the first day, the third day and the seventh day after operation. There was no significant difference in coagulation function between the two groups (P> 0.05). Conclusion: Midazolam can effectively regulate immune balance in patients with acute traumatic brain injury and improve the stress state, and has a good protective effect on brain tissue.