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全凭静脉麻醉和静吸复合麻醉对神经外科手术中高血压患者PGI2TXA2平衡的影响
Effects of balanced anesthesia and total intravenous anesthesia on the balance of PGI2/TXA2 in neurosurgical patients with hypertension
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DOI:
作者:
陈莺,武勇,赵志斌
CHEN Ying, WU Yong, ZHAO Zhi-bing
作者单位:
连云港市第一人民医院麻醉科
Department of Anesthesiology, The first People’s Hospital of Lianyungang
关键词:
全凭静脉麻醉;静吸复合麻醉;神经外科;高血压;PGI2 /TXA2
otal intravenous anesthesia; Balanced anesthesia; Neurosurgery; Hypertension; PGI2 /TXA2
摘要:
【摘要】目的 比较全凭静脉麻醉和静吸复合麻醉对高血压患者/非高血压患者神经外科手术后血浆TXA2和PGI2的稳定代谢产物TXB2、6-K-PGF1α表达和血小板聚集率的影响。方法 选择ASA I~Ⅱ级择期进行神经外科手术患者80例,随机分为静吸复合麻醉对照组(A)、静吸复合麻醉+高血压组(B)、全凭静脉麻醉对照组(C)、全凭静脉麻醉+高血压组(D),每组n=20。在手术前(T0)、手术后2小时(T1)和24小时(T2)测定TXB2、6-K-PGF1α表达和血小板聚集率的变化。结果 1. A组和C组6-K-PGF1α和TXB2表达在各时间点无明显变化,B组6-K-PGF1α和TXB2表达在T1时与T0相比较明显降低(P<0.01),在T2时却再次回复升高,其中6-K-PGF1α表达与T0相比较差异有显著性(P<0.05)D组6-K-PGF1α和TXB2表达在T0、T1、T2均逐步下降,T2时与T0相比较均差异有显著性(P<0.01,P<0.01)。在T2时D组6-K-PGF1α和TXB2表达明显低于B组(P<0.01)。2. A组和C组P/T(PGI2/TXA2)比值和血小板聚集率在各时间点比较差异无显著性,B组P/T比值在T1时与T0相比较明显升高(P<0.01),在T2时比值却有降低,而血小板聚集率在T1时降低(P<0.01),在T2时略有回复升高。D组P/T比值在T0、T1、T2逐步升高,血小板聚集率逐步降低。在T2时D组血小板聚集率明显低于B组(P<0.05)。结论 对高血压患者在神经外科患者手术中,全凭静脉麻醉较静吸复合麻醉能更好维持患者术后PGI2 /TXA2 的平衡,从而抑制血小板聚集。在非高血压患者中两种麻醉方法结果比较无明显差异。
【Abstract】 Objective To compare the effects of balanced anesthesia and total intravenous anesthesia on the contents of PGI2/TXA2(actually the stable products of metabolism: TXB2 and 6-K-PGF1α) and platelet aggregation function in neurosurgical patients with hypertension or normal. Methods 80 neurosurgical patients were randomly divided into four groups(n=20): balanced anesthesia group(A), balanced anesthesia with hypertension group(B), total intravenous anesthesia group(C), total intravenous anesthesia with hypertension group(D). The contents of PGI2,TXA2 and ratio of P/T(PGI2/TXA2) were detected at before anesthesia(T0), 2h Post anesthesia(T1), 24h Post anesthesia(T2). Platelet aggregation test(PAgT) was also measured at these time points. Results 1. Compared with the contents of PGI2 and TXA2 at T0, the contents were decreased obviously at T1(P<0.01), then increased at T2 in B groups. The contents gradually decreased in D group from T0 to T2, but no differences in A and C groups. The contents at T2 in D group were lower significantly compared to that of B group(P<0.01). 2. In B group, ratio of P/T was firstly increased at T1(P<0.01) and then decreased at T2, meanwhile the level of PAgT was decreased at T1(P<0.01) and then increased at T2. Ratio of P/T was increased and the level of PAgT was decreased gradually in D group, but no differences in A and C groups. The level of PAgT at T2 in D group were lower significantly compared to that of B group(P<0.05). Conclusion Total intravenous anesthesia depresses platelet aggregation function by maintaining the balance of PGI2/TXA2, which is more efficiently than balanced anesthesia in neurosurgical patients with hypertension. There are no differences in patients with normaltensive.
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