CAJ | 학술논문

目的探讨高位胸段硬膜外阻滞(HTEB)对原发性高血压合并左心室肥大老年病人淋巴细胞β1肾上腺素能受体激酶(β1-ARK)mRNA表达的影响.方法拟行胃大部切除术的原发性高血压合并左心室肥大病人20例,性别不限,ASAⅡ或Ⅲ级,年龄65～75岁,随机分为2组(n=10):静吸复合全麻组(Ⅰ组)和HTEB+静吸复合全麻组(Ⅱ组).Ⅱ组经T6.7间隙行硬膜外穿刺,采用罗哌卡因行HTEB,至术后72 h;Ⅰ组术后72 h内行芬太尼病人自控静脉镇痛.于入室30 min(基础状态)、意识完全恢复时(T1)、术后第1天(T2)、第3天(T3)及第5天(T4)记录心率变异性(HRV)各指标:总功率(TP)、高频功率(HF)、低频功率(LF),并计算LF/HF;同时行视觉模拟评分(VAS),评价疼痛程度;测定淋巴细胞β1-ARK mRNA及其底物β1-arrestin mRNA的表达水平.结果两组各时点VAS评分差异无统计学意义(P>0.05);与Ⅰ组比较,Ⅱ组术后TP、HF、LF和LF/HF升高,淋巴细胞β1-ARK mRNA表达下调(P<0.05或0.01),β1-arrestin mRNA表达差异无统计学意义(P>0.05);与T1时比较,两组T2时TP升高、HF降低,β1-ARK mRNA表达上调(P<0.05),其余时点差异无统计学意义(P>0.05).围术期TP与淋巴细胞β1-ARK mRNA表达水平呈负相关(r=-0.520,P<0.01).结论 HTEB可有改善原发性高血压合并左心室肥大老年病人上腹部手术围术期的心脏自主神经调节功能,其机制与抑制β1-ARK mRNA表达上调有关.
목적 탐토고위흉단경막외조체(HTEB)대원발성고혈압합병좌심실비대노년병인림파세포β1신상선소능수체격매(β1-ARK)mRNA표체적영향.방법 의행위대부절제술적원발성고혈압합병좌심실비대병인20례,성별불한,ASAⅡ혹Ⅲ급,년령65～75세,수궤분위2조(n=10):정흡복합전마조(Ⅰ조)화HTEB+정흡복합전마조(Ⅱ조).Ⅱ조경T6.7간극행경막외천자,채용라고잡인행HTEB,지술후72 h;Ⅰ조술후72 h내행분태니병인자공정맥진통.우입실30 min(기출상태)、의식완전회복시(T1)、술후제1천(T2)、제3천(T3)급제5천(T4)기록심솔변이성(HRV)각지표:총공솔(TP)、고빈공솔(HF)、저빈공솔(LF),병계산LF/HF;동시행시각모의평분(VAS),평개동통정도;측정림파세포β1-ARK mRNA급기저물β1-arrestin mRNA적표체수평.결과 량조각시점VAS평분차이무통계학의의(P>0.05);여Ⅰ조비교,Ⅱ조술후TP、HF、LF화LF/HF승고,림파세포β1-ARK mRNA표체하조(P<0.05혹0.01),β1-arrestin mRNA표체차이무통계학의의(P>0.05);여T1시비교,량조T2시TP승고、HF강저,β1-ARK mRNA표체상조(P<0.05),기여시점차이무통계학의의(P>0.05).위술기TP여림파세포β1-ARK mRNA표체수평정부상관(r=-0.520,P<0.01).결론 HTEB가유개선원발성고혈압합병좌심실비대노년병인상복부수술위술기적심장자주신경조절공능,기궤제여억제β1-ARK mRNA표체상조유관.
Objective To investigate the effect of high thoracic epidural block (HTEB) on the expression of β-adrenergie receptor kinaseo-1 (β1-ARK) mRNA in the lymphocytes in the elderly patients with essential hypertension complicated with left ventricular hypertrophy (LVH). Methods Twenty ASA Ⅱ or Ⅲ elderly patients with essential hypertension complicated with LVH scheduled for subtotal gastrectomy under general anesthesia were randomly divided into 2 groups (n = 10 each) : intravenous-inhalational anesthesia group (group Ⅰ) and HTEB combined with intravenous-inhalational anesthesia group (group Ⅱ). In group Ⅱ , epidural anesthesia was performed at T6.7 and ropivacaine was infused until 72 h after operation for HTEB. In group Ⅰ ,patient-controlled intravenous analgesia (PCIA) was performed with fentanyl in 72 h after operation. The heart rate variability (HRV) parameters, including total power (TP), high frequency (HF) power and low frequency (LF) power, were recorded 30 min after entering the operating room (baseline), at the recovery time of consciousness (T1), and on 1st, 3rd and 5th day after operation (T2-4) ,and LF/HF was calculated. VAS scores were recorded and the severity of pain was assessed. The blood samples were drawn from the right internal jugular vein at the time points mentioned above for determination of β1-ARK mRNA and β1-arrestin mRNA expression. Resets There were no significant differences in VAS scores at each time point between two groups (P > 0.05). TP, HF, LF and LF/HF were significantly increased, and β1-ARK mRNA expression was down-regulated after operation in group Ⅱcompared with group Ⅰ (P < 0.05 or 0.01), but there was no significant difference in β1-arrestin mRNA expression between group Ⅰ and Ⅱ (P > 0.05) . TP was siguificantly increased, HF significantly decreased, and β1-ARK mRNA expression up-regulated in two groups at T2 compared with those at T1 (P < 0.05), but no significant difference was found at the other time points (P > 0.05). TP was inversely correlated with the expression of β1-ARK mRNA in the lymphocytes during the perioperative period using Pearson correlation analysis (r=-0.520, P <0.01). Conclusion HTEB can maintain the balance of the autonomic nervous system and improve HRV during upper abdominal surgery in the elderly patients with essential hypertension complicated with LVH, and the mechanism is related to the up-regulation of β1-ARK mRNA expression.