摘要
目的观察腹腔镜胆囊切除术治疗老年胆囊结石的围术期应激并分析应激反应的影响因素。方法选择本院2012年6月至2015年6月所收治老年胆囊结石患者107例进行回顾性分析，均行腹腔镜胆囊切除术。于麻醉开始前、手术结束时与术后1d、2d、3d、5d检测患者内皮素（ET）与超氧化物岐化酶水平（SOD），根据107例患者手术时间的不同（≤60rain、〉60min）、麻醉方式的不同[硬膜外麻醉复合全麻（GEA）、全麻（GA）]对患者ET与SOD指标进行分组统计并比较。结果麻醉开始后患者ET与SOD均呈现下降趋势，术后1d及术后2d的ET水平分别为（35．2±7．0）μml、f35．8±6．1）μml，手术结束时、术后1d的SOD分别为（62．1±9．5）U／m1、（65．3±8．8）U／ml，均显著低于麻醉开始前俨〈0．05）。手术时间≤60min患者术后1d与术后2d的ET分别为（30．4±4．4）μml、（35．5±3．2）μml，均低于手术时间〉60min患者俨〈0．05）；手术结束与术后1d的SOD分别为（66．4±6．3）U／m1、（67．6±5．1）U／ml，均高于手术时间〉60min患者沪〈0．05）。GEA患者术后1d与术后2d的ET分别为f30．6±3．8）pgml、（35-3±4．1）μml，均低于GA患者俨〈0．05）；手术结束与术后1d的SOD分别为（66．1±5．0）U／ml、（67．8±4．5）U／ml，均高于GA患者沪〈0．05）。提示手术时间≤60min与GEA麻醉方式所引起围手术期应激反应更轻。结论腹腔镜胆囊切除术治疗老年胆囊结石患者围术期往往存在明显应激，且手术时间及麻醉方式对应激程度有较大影响，可尽量缩短手术时间并采取GEA麻醉方式减轻患者应激反应。
[ Abstract ] Objective To observe the perioperative stress of laparoscopic cholecystectomy for elderly patients with gallbladder stone and its influencing factors. Methods 107 elderly patients with gallbladder stone treated at our hospital from June, 2012 to June, 2015 were selected and retrospectively analyzed. All the patients underwent laparoscopic cholecystectomy. Before anesthesia, at the end of the operation, and 1, 2, 3, and 5 days after the operation, the levels of endothelial prime （ET） and superoxide dismutase （SOD） were detected. The 107 patients were grouped according to different operation times （ ~〈 60 min and 〉60 min） and different anesthesia methods [epidural anesthesia combined with general anesthesia （GEA） and general anesthesia （GA）]. The levels of ET and SOD were compared between these two groups. Results The levels of ET and SOD were decreasing from the beginning of anesthesia. At the end of operation and 1 and 2 days after the operation, the levels of ET were （35.2±7.0）pg/ml, and （35.8±6.1）pg/ml, respectively. At the end of operation and 1 day after the operation, the levels of SOD were （62. 1±9.5）U/ml and （65.3±8.8）U/ml, respectively. 1 and 2 days after the operation, the levels of ET were （30.4±4.4）pg/ml and （35.5±3.2）pg/ml in the patients whose operation time 〈60 min, respectively, which were lower than those in the patients whose operation time 〉60 min （P〈0.05）. At the end of operation and 1 day after the operation, the levels of SOD were （66.4±6.3）U/ml and （67.6±5.1）U/ml in the patients whose operation time ~〈 60 min, respectively, which were higher than those in the patients whose operation time 〉60 min （P〈0.05）. 1 and 2 days after the operation, the levels of ET were （30.6±3.8）pg/ml and （35.3±4.1）pg/ml in the GEA patients, respectively, which were lower than those in the GA patients （P〈0.05）. At the end of operation and 1 day after the operation, the levels of SOD were （66. 1±5.0）U/ml and （67.8±4.5）U/ml in the GEA patients, respectively, which were higher than those in the GA patients （P〈0.05）. Operation time 〈60 min and GEA anesthesia induced milder per^operative stress. Conclusions Laparoscopic cholecystectomy for elderly patients with gallbladder stone has obvious perioperative stress; operation time and anesthesia methods significantly influence stress; Shortening operation time and GEA can relieve stress.
出处
《国际医药卫生导报》
2016年第18期2796-2799,共4页
International Medicine and Health Guidance News
关键词
胆囊结石
腹腔镜胆囊切除术
应激反应
麻醉
手术时间
Gallbladder stone
Laparoscopic cholecystectomy
Stress response
Anesthesia
Operation time
