CAJ | 학술논문

[目的]探讨镇痛、镇静、镇痛复合镇静对脓毒症小鼠炎性细胞因子及病死率的影响，为临床镇静、镇痛治疗提供参考。[方法]通过建立脓毒症小鼠模型，将90只小鼠随机分为假手术组（C组）、模型组（M组）、芬太尼组（F组）、咪达唑仑组（M D组）、芬太尼＋咪达唑仑组（F＋ M D组），比较各组小鼠之间用药前后炎症因子白细胞介素-1（IL-1）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）、降钙素原（PCT ）和C反应蛋白（CRP）水平的变化，同时比较各组小鼠病死率的差别。[结果]与C组相比，M 组小鼠血清PCT、CRP、TNF-α、IL-1和IL-10水平显著上升，有显著性差异（ P ＜0．05）。与M 组相比，MD组CRP、IL-10和 TNF-α水平明显下降（ P ＜0．05），F组和F＋MD组TNF-α水平均下降，但差异无显著性。各脓毒症小鼠亚组病死率相比较，M 组最高（50％），MD组最低（21．05％），F＋M D组病死率与F组相近（40％和38．1％）。[结论]镇静、镇痛通过减轻抗炎反应和抑炎反应两种镇静免疫机制调节脓毒症小鼠的炎症反应，从而降低脓毒症小鼠的病死率。药物选择方面，咪达唑仑优于芬太尼或芬太尼复合咪达唑仑。
[목적]탐토진통、진정、진통복합진정대농독증소서염성세포인자급병사솔적영향，위림상진정、진통치료제공삼고。[방법]통과건립농독증소서모형，장90지소서수궤분위가수술조（C조）、모형조（M조）、분태니조（F조）、미체서륜조（M D조）、분태니＋미체서륜조（F＋ M D조），비교각조소서지간용약전후염증인자백세포개소-1（IL-1）、백세포개소-10（IL-10）、종류배사인자-α（TNF-α）、강개소원（PCT ）화C반응단백（CRP）수평적변화，동시비교각조소서병사솔적차별。[결과]여C조상비，M 조소서혈청PCT、CRP、TNF-α、IL-1화IL-10수평현저상승，유현저성차이（ P ＜0．05）。여M 조상비，MD조CRP、IL-10화 TNF-α수평명현하강（ P ＜0．05），F조화F＋MD조TNF-α수평균하강，단차이무현저성。각농독증소서아조병사솔상비교，M 조최고（50％），MD조최저（21．05％），F＋M D조병사솔여F조상근（40％화38．1％）。[결론]진정、진통통과감경항염반응화억염반응량충진정면역궤제조절농독증소서적염증반응，종이강저농독증소서적병사솔。약물선택방면，미체서륜우우분태니혹분태니복합미체서륜。
[Objective] To explore the effect of analgesia ,sedation and analgesia combined with sedation on inflam-matory cytokines and the mortality rate of septic mice so as to provide the reference for clinical sedative and analgesic ther-apy .[Methods] After establishment of mouse model with sepsis ,90 mice were randomly divided into sham operation group(group C) ,model group(group M) ,fentanyl group(group F) ,midazolam group(group MD) and midazolam plus fentanyl group(group F+MD) .The changes of inflammatory factors including interleukin-1(IL-1) ,interleukin-10(IL-10) ,tumor necrosis factor-alpha(TNF-α) ,procalcitonin(PCT) and C-reactive protein(CRP) before and after medication were compared among groups .The difference of mortality rate among groups was also compared .[Results]Compared with group C ,serum levels of PCT ,CRP ,TNF-α,IL-1 and IL-10 in group M were increased markedly ,and there was significant difference( P<0 .05) .Compared with group M ,the levels of CRP ,TNF-αand IL-10 in group MD were de-creased obviously( P<0 .05) .The level of TNF-αin group F and group F+MD was decreased ,but there was no signifi-cant difference .Among different subgroups of septic mice ,the mortality rate in group M was the highest (50% ) ,and that in group MD was the lowest(21 .05% ) .The mortality rate in group F+MD was similar to group F(40% and 38 .1% , respectively ) .[Conclusion]Sedation and analgesia can regulate the inflammatory reaction of septic mice through two seda-tion-immune mechanisms such as the inhibition of proinflammatory and anti-inflammatory factors so as to reduce the mor-tality rate of septic mice .Regarding medicine selection ,midazolam is superior to fentanyl or fentanyl plus midazolam .