| 84 | 7 | 16 |
| 下载次数 | 被引频次 | 阅读次数 |
目的:研究全身麻醉对腹部手术患者凝血功能、应激反应及其他相关因子水平的影响。方法:选取我院收治并拟行腹部腔镜手术的患者94例,随机分为对照组和观察组,每组47例。在相同前处理的基础上,对照组实施硬膜外麻醉,观察组实施静吸全身麻醉,对两组凝血功能、应激反应以及其他相关因子水平进行检测和比较。结果:T1时,两组凝血功能(D-Dimer、APTT、PT、PLT)、应激反应(COR、ACTH、CRP、ET-1)以及其他相关因子(IL-23、IL-32、M-CSF、PRL、PCT、NO、TNF-α)水平之间不存在统计学差异(P>0.05);T2和T3时,两组应激反应(COR、ACTH、CRP、ET-1)以及其他相关因子(IL-23、IL-32、M-CSF、PRL、PCT、NO、TNF-α)水平之间存在统计学差异(P<0.05)。结论:在腹部腔镜手术中应用静吸全身麻醉,与硬膜外麻醉相比对患者的凝血功能不会有显著的改变,能够维持稳定的凝血功能状态,但其对于患者的应激反应指标以及其他相关因子IL-23、IL-32、M-CSF、PRL、PCT、NO、TNF-α具有更好的稳定作用,值得临床上进一步研究。
Abstract：Objective:To study the effects of general anesthesia on coagulation function,stress response and other correlation factors in patients undergoing abdominal operation.Methods:A total of 94 cases of patients undergoing abdominal operation in our hospital from February 2016 to April 2018 were selected and divided into the control group and observation group,with 47 cases in each group.On the basis of the same pre-processing,the patients in the control group were given epidural anesthesia,and the patients in the observation group received general anesthesia.The coagulation function,stress response and other correlation factors were detected and compared between the two groups.Results:At T1,the levels of coagulation function(D-Dimer,APTT,PT,PLT),stress response(COR,ACTH,CRP,ET-1)and other correlation factors(IL-23,IL-32,M-CSF,PRL,PCT,NO,TNF-α)between the two groups had no statistical difference(P>0.05).At T2 and T3,the levels of coagulation function(D-Dimer),stress response(COR,ACTH,CRP,ET-1)and other correlation factors(IL-23,IL-32,M-CSF,PRL,PCT,NO,TNF-α)between the two groups had statistical difference(P<0.05).Conclusion:Application of general anesthesia in abdominal endoscopic operation does not significantly change coagulation function of patients compared with epidural anesthesia and it can maintain stable coagulation function.However,it has a better stabilizing effect on stress response indexes and other correlation factors such as IL-23,IL-32,M-CSF,PRL,PCT,NO and TNF-α;it is worthy of further clinical study.
1任元华,赵永军,吴超贤.不同麻醉方式对腹腔镜胆囊切除术患者CRP及补体C3C4的影响分析[J].河北医学,2017,23(11):1784-1787.
2 Shi ZY,Jiang CN,Shao G.Application of lower limb nerve block combined with slow induction of light general anesthesia and tracheal induction in elderly hip surgery[J].Medicine(Baltimore),2018,97(40):e12581.
3 王海峰.腹腔镜胆囊切除术患者行全身麻醉复合硬膜外麻醉对血栓素A2、血浆内皮素和免疫功能的影响研究[J].中国内镜杂志,2016,22(1):70-75.
4 Yao ZY,Jia Z,Xie YH,et al.Analgesic effect of dezocine in different doses on elderly patients undergoing abdominal operation under general anesthesia and its influence on stress response to postoperative tracheal extubation[J].Eur Rev Med Pharmacol Sci,2017,21(22):5223-5229.
5 马华山,刘金山,田玲,等.高龄全膝关节置换中全麻和硬膜外麻醉对凝血功能的影响[J].中国组织工程研究,2015,19(35):5610-5614.
6 Bruckner S,Reinke U,Roth A,et al.Comparison of general and spinal anesthesia and their influence on hemostatic markers in patients undergoing total hip arthroplasty[J].J Clin Anesth,2003,9(15):433-440.
7 Crippa J,Mari GM,Miranda A,et al.Surgical stress response and enhanced recovery after laparoscopic surgery a systematic review[J].Chirurgia(Bucur),2018,113(4):455-463.
8 张懿,苏文君,蒋春雷.应激生理指标皮质醇和α-淀粉酶的研究进展[J].军事医学,2017,41(2):146-149.
9 MacFater WS,Xia W,Barazanchi A,et al.Intravenous local anaesthetic compared with intraperitoneal local anaesthetic in abdominal surgery:A systematic review[J].World J Surg,2018,42(10):3112-3119.
10 Wang L,Liu F,Luo Y,et al.Effect of acute heat stress on adrenocorticotropic hormone,cortisol,interleukin-2,interleukin-12and apoptosis gene expression in rats[J].Biomed Rep,2015,3(3):425-429.
11 Akbulut I,Ozguler O,Burma A,et al.Rosuvastatin lowers systemic inflammatory response in coronary artery bypass graft accompanied by cardiopulmonary bypass surgery:a randomized controlled study[J].Clinical and Investigative Medicine,2015,38(4):E154-163.
12 赵华堂,张西增,刘爱杰,等.丙泊酚与七氟醚用于后腹腔镜手术患者对血浆TXB2、ET-1、D-D水平的影响比较[J].现代生物医学进展,2017,17(24):4727-4730.
13 Ahmed AH,Maulood IM.Endothelin-1and angiotensin-II modulate urotensin-II vasoconstriction in rat aorta exposed to mercury[J].Bratisl Lek Listy,2018,119(7):444-449.
14 杨芬,魏磊,王幸双,等.不同麻醉方法对结直肠肿瘤腔镜手术患者IL-17和IL-23的影响[J].河南医学高等专科学校学报,2016,28(4):272-275.
15 Yan H,He D,Huang X,et al.Role of interleukin-32in cancer biology[J].Oncol Lett,2018,16(1):41-47.
16 王春玲,武金才,麦蕊,等.减轻应激训练在肝癌患者中的应用对巨噬细胞集落刺激因子-1表达的影响[J].广东医学,2017,38(5):733-735.
17 Munoz JL,Ruiz-Tovar J,Miranda E,et al.C-Reactive protein and procalcitonin as early markers of septic complications after laparoscopic sleeve gastrectomy in morbidly obese patients within an enhanced recovery after surgery program[J].J Am Coll Surg,2016,222(5):831-837.
18 王芳,姜文,邢梅,等.腰硬联合麻醉复合术后硬膜外镇痛对足月妊娠初产妇无痛分娩产程时间及术后血清PRL、tPA水平的影响[J].中国医学前沿杂志(电子版),2018,10(8):60-64.
19 英成光,张传蕾,马加旭.局麻和全麻对病人血清NO、PRL水平影响的初步探讨[J].中国医疗前沿,2009,4(21):7,24.
20 Ciorba A,Corazzi V,Bianchini C,et al.Sudden sensorineural hearing loss:Is there a connection with inner ear electrolytic disorders.A literature review[J].Int J Immunopathol Pharmacol,2016,29(4):595-602.
21 夏敏,周旺辉.全身麻醉联合硬膜外麻醉与单纯全身麻醉对宫颈癌手术围术期的一氧化氮和P物质水平及效果比较[J].中国妇幼保健,2016,31(19):4070-4074.
22 赵鹏鹏.硬膜外麻醉与全身麻醉对老年患者术后认知功能及血清TNF-α水平的影响[J].河南医学研究,2017,26(10):1817-1818.
23 Afuwape OO,Ayandipo OO,Kuti M,et al.Tumor necrosis factor-alpha and interleukin-1alpha as predictors of survival in peritonitis:A pilot study[J].Niger J Surg,2018,24(2):107-110.
基本信息:
DOI：10.13210/j.cnki.jhmu.20181114.004
中图分类号:R614.2
引用信息:
[1]李勇,赵玲,段锦玉.全身麻醉对腹部手术患者凝血功能、应激反应及其他相关因子水平的影响[J].海南医学院学报,2018,24(23):2045-2049.DOI:10.13210/j.cnki.jhmu.20181114.004.
基金信息:
陕西省自然科学基金(2012JQ4005)~~
2018-11-16
2018-11-16
2018-11-16