Effects of remifentanil combined with propofol on hemodynamics and inflammatory stress in patients with septic shock

Linyang YE; Yangyang Nie; Qingxiang Wang; Xi Huang; Weijie Chen; Zhenyi Chen

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Effects of remifentanil combined with propofol on hemodynamics and inflammatory stress in patients with septic shock

VernacularTitle: 瑞芬太尼复合丙泊酚对感染性休克患者血流动力学及炎症应激反应的影响
Author: Linyang YE ¹ ; Yangyang NIE ; Qingxiang WANG ; Xi HUANG ; Weijie CHEN ; Zhenyi CHEN
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1. Department of Anesthesiology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, China
Publication Type:Journal Article
Keywords: Shock, septic; Abdomen, acute; Anesthetics, combined; Remifentanil; Propofol; Hemodynamics; C reactive protein; Tumor necrosis factor-α lpha; Interleukin6; Epinephrine; Hydrocortisone; T-Lymphocytes
From: Chinese Journal of Primary Medicine and Pharmacy 2019;26(11):1325-1330
CountryChina
Language:Chinese
Abstract: Objective:To investigate the effects of remifentanil combined with propofol on hemodynamics, inflammatory stress response and immune function in patients with acute abdomen complicated with septic shock.
Methods:From June 2017 to August 2018, 112 patients with acute abdomen complicated with septic shock who admitted to the First Affiliated Hospital of Xiamen University were enrolled in the study.They were randomly divided into observation group and control group according to the digital table, with 56 cases in each group.The control group was anesthetized with sevoflurane combined with propofol.The observation group was anesthetized with remifentanil combined with propofol.The hemodynamic parameters of the patients entering the operating room(T0₎, 0.5h(T₁), 1h(T₂) and awake(T₃) after anesthesia were recorded.The intraoperative norepinephrine dosage was recorded.The inflammatory response, stress response and immune function indicators at T₀, T₂ and T₃ were recorded.
Results:Compared with T₀, T₁ and T₂, the MAP of the two groups was higher at T₃, and the differences were statistically significant(t_{control group}=4.834, 4.484, 5.378, t_{observation group}=6.420, 7.006, 6.152, all P<0.05). Compared with T₀, the HR of the two groups was higher at T₃, and the differences were statistically significant(t_{control group}=5.943, t_{observation group}=7.722, all P<0.05). Compared with T₁ and T₂, CO of the two groups was higher at T₃, and the differences were statistically significant(t_{control group}=4.276, 2.262, t_{observation group}=6.318, 5.132, all P<0.05). There were no statistically significant differences in MAP, HR and CO between the two groups at T₀, T₁, T₂ and T₃(all P>0.05). The doses of norepinephrine in the observation group and the control group were (1 587.7±287.5)μg and (1 937.9±397.6)μg, respectively, and the difference was statistically significant(t=5.341, P<0.05). The serum levels of C reactive protein(CRP), tumor necrosis factor alpha(TNF-α) and interleukin 6(IL-6) increased with time in the two groups, and the differences were statistically significant(t_{control group}=17.06, 36.13, 19.07, 3.822, 9.466, 2.874, 14.18, 26.87, 16.21, t_{observation group}=11.72, 20.79, 11.01, 2.810, 6.559, 3.716, 10.52, 24.56, 17.64, all P<0.05). At T₂ and T₃, the serum levels of CRP, TNF-α and IL-6 in the observation group[T₂: CRP (89.63±17.65)mg/L, TNF-α (51.16±10.16)ng/L, IL-6 (34.26±6.25)ng/L, T₃: CRP (136.15±26.25)mg/L, TNF-α (58.64±11.12)ng/L, IL-6 (67.56±12.67)ng/L]were lower than those in the control group[T₂: CRP (112.15±22.34)mg/L, TNF-α (59.56±11.58)ng/L, IL-6 (42.65±8.37)ng/L, T₃: CRP (175.16±34.75)mg/L, TNF-α (65.79±11.35)ng/L, IL-6 (79.02±14.56)ng/L], the differences were statistically significant(t=5.919, 6.703, 4.080, 3.367, 6.010, 4.443, all P<0.05). Compared with T0, serum levels of epinephrine(E), cortisol(Cor) increased in two groups at T₂ and T₃, and the differences were statistically significant(t_{control group}=10.03, 8.096, 8.679, 7.029, t_{observation group}=6.473, 4.728, 6.330, 4.727, all P<0.05). Compared with T₂, serum levels of E and Cor in two groups at T₃ were decreased, and the differences were statistically significant(t_{control group}=2.400, 2.638, t_{observation group}=2.260, 2.162, all P<0.05). At T₂ and T₃, the serum levels of E, Cor in the observation group[T₂: E (286.36±41.02)ng/L, Cor (262.52±29.89)μg/L, T₃: E (270.35±33.59)ng/L, Cor (253.23±30.28)μg/L]were lower than those in the control group[T₂: E (312.56±38.75)ng/L, Cor (287.56±38.76)μg/L, T₃: E (295.79±35.12)ng/L, Cor (270.25±30.15)μg/L], the differences were statistically significant (t=3.457, 3.917, 3.828, 2.981, all P<0.05). At T₀, T₂ and T₃, there were no statistically significant differences in CD₃⁺, CD₄⁺, CD₈⁺ and CD₄⁺/CD₈⁺ between the two groups(all P>0.05).
Conclusion:Remifentanil combined with propofol anesthesia can make hemodynamics more stable in patients with acute abdomen complicated with septic shock, and can alleviate inflammation and stress response.