瑞芬太尼对房室间隔残缺损快通道麻醉患儿脑组织代谢及血浆Glu、GABA表达的影响*

Effect of Remifentanil on brain metabolism and expression of plasma Glu and GABA in children with fast interventricular residual defective anesthesia*

摘要:

目的 探讨瑞芬太尼用于房室间隔残缺损快通道麻醉患儿对机体的应激反应、脑组织代谢以及血浆谷氨酸（Glu）、γ-氨基丁酸（GABA）表达的影响。方法 选取2016年9月—2017年3月上海儿童医学中心择期实施手术的52例房室间隔缺损的患儿，分为观察组（瑞芬太尼）和对照组（芬太尼），每组26例。两组均采用快通道麻醉方式，其中观察组给予瑞芬太尼，对照组给予小剂量芬太尼，比较两组在麻醉前（T0）、劈胸骨（T1）、复温3 min时（T2）、术毕（T3）及气管拔除时（T4）的平均动脉压（MAP）、心率（HR）、肾上腺素（E）、乳酸差（ADVL）、脑摄氧率（O2Ext）、动脉-颈静脉血氧浓度差（Ca-jvO2）、动静脉血糖差（Ga-j）以及谷氨酸（Glu）、γ-氨基丁酸（GABA）的差异。结果 T1～T4阶段两组的MAP、HR、E均呈现上升趋势，T4时观察组的MAP、HR高于对照组，而E低于对照组；观察组Ga-j波动浮动小于对照组Ga-j波动浮动；两组Ca-jvO2均呈现先降后升的趋势，ADVL呈现先升后降趋势，且观察组指标改善优于对照组；但是两组O2Ext的变化趋势无差异；此外，两组Glu及GABA水平也呈现下降趋势，但观察组的Glu及GABA水平均高于同期对照组。结论 瑞芬太尼应用于房室间隔残缺损患儿手术，可有效下调机体应激反应、改善脑组织代谢、减少脑组织损伤。

Abstract:

Objective To investigate the effects of Remifentanil on stress response, brain metabolism, and plasma glutamate (Glu) and gamma aminobutyric acid (GABA) expression in children with fast-channel anesthesia for atrioventricular septal defects. Methods A total of 52 patients with atrioventricular septal defect undergoing elective surgery in Shanghai Children's Medical Center from September 2016 to March 2017 were included in the observation group (Remifentanil) and the control group (Fentanyl), 26 cases in each group. Fast-channel anesthesia was used in both groups. Remifentanil was administered to the observation group and Fentanyl was given to the control group. The two groups were compared in mean arterial pressure (MAP), heart rate (HR), epinephrine (E), lactic acid difference (ADVL), oxygen uptake (O2Ext), arterial-jugular vein Differences in blood oxygen concentration (Ca-jvO2), arteriovenous blood glucose (Ga-j), and glutamic acid (Glu) and gamma-aminobutyric acid (GABA) before the anesthesia (T0), at the sternum (T1), the rewarming time (T2) the end of surgery (T3) and trachea removal (T4). Results The MAP, HR, and E of the two groups showed an increasing trend from T1 to T4. The MAP and HR of the T4 observation group were significantly higher than that of the control group, while E was significantly lower than that of the control group. Ga-j fluctuating fluctuation in the observation group was smaller than that in the control group Ga-j fluctuation; the two groups Ca-jvO2 showed a trend of falling first and then rising, and the ADVL showed a trend of rising first and then decreasing, and the observation group improved better than the control group. However, there was no significant difference between the two groups in O2Ext comparison. In addition, the Glu and GABA levels in both groups also showed a downward trend. However, the Glu and GABA levels in the observation group were higher than those in the control group. Conclusions Remifentanil was used for surgery of children with atrioventricular septal defects. It can effectively reduce the body's stress response, improve brain metabolism, and reduce brain tissue damage.