吸入麻醉在肿瘤和创伤病理患儿手术治疗中镇痛和抗应激作用的比较研究

V. Snisar, D.V. Myronov
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引用次数: 0

摘要

背景。充分的麻醉对患者安全非常重要,它可以减少手术和创伤的应激反应。现代麻醉技术的完善,使得手术和麻醉风险高的患者可以在不同年龄阶段进行复杂的手术。为了限制手术过程中神经内分泌、炎症和免疫反应的激活,人们不断探索新的麻醉方法,对不同的吸入性和非吸入性麻醉药物进行比较,以期找到理想的“无应激”麻醉。目前,在癌症手术中,七氟醚被广泛使用,但很少有研究表明这种吸入麻醉剂在儿童肿瘤手术治疗中的有效性,以及它对手术创伤和儿童身体对应激反应的影响。我们研究的目的是研究七氟醚在多大程度上限制了癌症手术期间儿童神经植物、炎症和免疫反应的激活。材料和方法。第一组27例,年龄1 ~ 17岁(6.04±5.84岁),接受肿瘤手术治疗。为比较研究指标,对23例2 ~ 17岁(10.68±4.21岁)儿童(第二组)进行额外检查,并择期行创伤病理手术治疗。结果。对癌症和创伤患者手术中七氟醚麻醉充分性的评估表明,大多数血流动力学参数在所有阶段都有相似的变化,这是此类麻醉的典型特征。我们研究了七氟醚麻醉前后癌症和创伤病理患儿c反应蛋白和循环细胞因子的变化。c反应蛋白水平增加了4倍,但癌症患者最初的水平是2-2.5倍。促炎细胞因子(白细胞介素-6和肿瘤坏死因子)也表现出类似的动态。手术干预结束时,皮质醇显著升高;然而,在第二组儿童中,与癌症患者相比,这种激素水平增加得更多。心率变异性的所有频谱指标证明自主神经系统的紧张程度,在两组之间有显著差异。结论。在七氟醚吸入麻醉期间,癌症患儿的应激反应与创伤病理患者的应激反应不同。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative study of the analgesic and anti-stress effect of inhalation anesthesia in children with cancer and trauma pathology during surgical treatment
Background. Adequate anesthesia is of great importance for patient safety, it reduces stress reactions to surgery and trauma. The perfection of modern anesthesia allows performing complex operations in different age periods in patients at high surgical and anesthetic risk. To limit the activation of neuroendocrine, inflammatory and immune reactions during surgery, new methods of anesthesia are constantly being searched for, different inhalation and non-inhalation drugs for anesthesia are compared in order to find an ideal “stress-free” anesthetic. Currently, during cancer surgeries, sevoflurane is widely used, but there are few studies showing efficiency of this inhalation anesthetic in children during surgical treatment of tumors and its effect on operative trauma and the reaction of the child’s body to stress. The purpose of our research is to study the extent to which sevoflurane limits the activation of neurovegetative, inflammatory, and immune responses in children during cancer surgery. Materials and methods. Twenty-seven children (first group) aged from 1 to 17 years (6.04 ± 5.84 years), who came for surgical treatment of cancer, were examined. To compare the studied indicators, 23 children (second group) aged from 2 to 17 years (10.68 ± 4.21 years) were additionally examined, they were scheduled for surgical treatment of trauma pathology. Results. Evaluation of the adequacy of sevoflurane anesthesia during operations in cancer and trauma patients showed that most hemodynamic parameters had similar changes at all stages, which is typical for this type of anesthesia. We studied changes in C-reactive protein and circulating cytokines before and after anesthesia with sevoflurane in children with cancer and trauma pathology. C-reactive protein level increased 4 times, but initially its level was 2–2.5 times higher in cancer patients. Similar dynamics was demonstrated with pro-inflammatory cytokines (interleukin-6 and tumor necrosis factor). By the end of surgical intervention, a significant increase of cortisol was noted; however, in the children of the second group, the level of this hormone increased more compared with cancer patients. All spectral indicators of heart rate variability, which testified to the tension of the autonomic nervous system, had a significant difference between the groups. Conclusions. During inhalation anesthesia with sevoflurane, the profile of stress response in children with cancer differs from that in patients with trauma pathology.
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