神经肌肉阻塞深度对术后系统性细胞因子释放的影响:系统性审查和元分析
Soowon Lee1,2,3, Jung-Hee Ryu1,2, Chang-Hoon Koo1,2
1Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
深度神经肌肉阻塞 (NMB) 可能会在手术后立即降低瘤死亡因子-α (TNF-α) 水平. 吸入麻醉和年轻的年龄可能会增加血清细胞因子,这表明NMB.
科学领域:
- 麻醉学和外科手术期间的医学.
- 免疫学和炎症 免疫学和炎症
- 手术科学 手术科学
背景情况:
- 深度神经肌肉阻塞 (NMB) 增强了手术条件,特别是在腹腔镜手术中.
- 深度NMB对全身细胞因子的影响,与麻醉并发症 (如妄想) 相关,尚不清楚.
- 本综述研究了NMB对血清细胞因子水平的深度影响.
研究的目的:
- 系统地审查和量化深度神经肌肉阻塞对手术患者血清细胞因子水平的影响.
- 探索NMB深度,麻醉技术,患者年龄和细胞因子概况之间的潜在关联.
主要方法:
- 在多个数据库 (PubMed,EMBASE,CENTRAL,CINAHL,Scopus,Web of Science,Google Scholar) 中进行了全面的文献搜索.
- 包括随机对照试验 (RCT),比较深度与中度NMB患者的血清细胞因子水平.
- 使用元分析和元回归来分析涉及661名患者的8项RCT的数据.
主要成果:
- 术后立即,深度NMB与瘤缩因子-α (TNF-α; SMD -0.48,P=0.03) 的潜在减少有关.
- 在手术后立即没有观察到白内素-1β (IL-1β) 或白内素-6 (IL-6) 的显著差异.
- 在术后24小时和48小时,IL-1β,IL-6,TNF-α或C反应蛋白没有发现显著差异. 吸入麻醉与较高的IL-1β和TNF-α相关,而年轻的年龄与中度NMB下较高的IL-1β相关.
结论:
- 深度NMB可能与手术后期TNF-α水平降低有关.
- 与TIVA和老年人相比,吸入麻醉和年轻患者年龄似乎与血清细胞因子水平的增加有关.
- 这些发现表明深度NMB的潜在免疫调节作用,需要进一步调查其临床意义.
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