使用α-2-肾上腺素受体激动剂进行神经外科手术时全身炎症实验室指标的动态变化

N. Lesteva, N. Dryagina, A. Kondratiev
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摘要

目的是研究在神经外科手术切除颅底肿瘤期间,在各种α-2-肾上腺素能受体调节交感神经系统反应的条件下,全身炎症反应综合征(SIRS)实验室参数的偏差程度。分析了 179 名接受脑膜下定位脑肿瘤手术的患者的实验室数据。手术在全静脉麻醉条件下进行。根据麻醉辅助结构中使用的α-2-肾上腺素能激动剂的不同,患者被分为两组:第一组使用氯尼替丁,第二组使用右美托咪定。实验室检查包括细胞因子(IL-8、IL-6、IL-10、TNF-α)、CRP、纤维蛋白原水平分析。研究的血液采样分五个阶段进行:1 - 手术前一天;2 - 手术当天麻醉诱导前;3 - 麻醉诱导后;4 - 肿瘤切除后(止血阶段);5 - 手术后第一天。两个研究组的实验室参数动态相似,反映了机体对颅内介入治疗的全身炎症反应表现。促炎细胞因子 IL-6、IL-8、TNF-α 和 C 反应蛋白(CRP)的水平在研究的第四和第五阶段有所上升。在研究的第五阶段,第二组的 IL-6 和纤维蛋白原水平的增加更为显著,这是因为右美托咪定的抗炎效果不如氯尼替丁明显。脑部手术干预反应的 SIRS 实验室参数变化是短暂的。在使用α-2-肾上腺素能激动剂进行全静脉麻醉的条件下,炎症反应得到了调节,从而确保了炎症过程的充分一致性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Dynamics of laboratory markers of systemic inflammation in neurosurgical operations using α-2-adrenoagonists
The objective was to study the degree of deviations of laboratory parameters of the systemic inflammatory response syndrome (SIRS) under the conditions of modulation of the reactions of the sympathetic nervous system by various α-2-adrenergic receptors during neurosurgical interventions for the removal of the brain tumor of subtentorial localizationMaterials and methods. The laboratory data of 179 patients operated for the brain tumor of subtentorial localization were analyzed. The operations were performed under conditions of total intravenous anesthesia. The patients were divided into two groups depending on the α-2-adrenergic agonist used in the structure of the anesthetic aid: clonidine was used in the first group, dexmedetomidine was used in the second group. Laboratory tests included analysis of the levels of cytokines (IL-8, IL-6, IL-10, TNF-α), CRP, fibrinogen. Blood sampling for the study was carried out in five stages: 1 – one day before the operation, 2 – on the day of the operation before the introductory anesthesia, 3 – after the induction anesthesia, 4 – after removal of the tumor (at the stage of hemostasis); 5 – on the first day after surgery.Results. The dynamics of laboratory parameters were similar in both study groups and reflected the manifestations of the systemic inflammatory response of the body to intracranial intervention. The levels of pro-inflammatory cytokines IL-6, IL-8, TNF-α, and C-reactive protein (CRP) increased in the fourth and fifth stages of the study. The increase in the level of IL-6 and fibrinogen in the fifth stage of the study in the second group was more significant, which was explained by the less pronounced anti-inflammatory effect of dexmedetomidine compared to clonidine.Conclusions. Changes in laboratory parameters of SIRS as the reaction to surgical intervention on the brain were transient. Under conditions of total intravenous anesthesia with the use of α-2-adrenergic agonists, modulation of the inflammatory response was demonstrated, which ensured adequate consistency of the inflammatory process.
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