摘要
目的分析膝关节微创外科围手术期创伤应激反应的激素水平、C-反应蛋白(CRP)和机体能量代谢的变化。方法膝关节半月板损伤病人16例,交叉韧带损伤病人26例,均为闭合性损伤。分为A组22例膝关节关节镜微创外科手术,B组20例切开关节直视下手术。两组患者于手术前1d,手术后1d和手术后3d早晨分别抽取空腹静脉血离体后检测胰岛素、生长激素、皮质醇、CRP。同时测定静息能量消耗(REE)和呼吸商(RQ)。结果胰岛素在B组患者手术后第3天与术前比较有明显下降。生长激素、皮质醇、CRP术后上升在B组明显高于A组(P<0.05)。两组患者静息REE术后较术前显著增加,而术后B组患者REE明显高于A组(P<0.05)。两组患者RQ术后较术前均有显著下降。结论膝关节关节镜微创外科手术创伤小,应激水平低,对患者代谢影响小,有利于机体应激激素、氮平衡和能量代谢的恢复。
Objective To evaluate the level of neurohormone and C-reactive protein (CRP), as well as the change of rest energy expenditure(REE) resulted from operative stress response due to micro invasive surgery in arthroscopy on knee joint. Methods 16 patients with meniscus lesions and 26 patients with cruciate ligament injuries who underwent micro invasive surgery on knee joint were divided into two groups. In these 42 cases,22 patients in group A were performed arthroscopy on knee joint, and 20 patients in group B were performed traditional surgery. Plasma concentrations of insulin, somatotropin, cortisol and CRP, as well as the level of REE and RQ were measured at the day preoperatively, 1 and 3-day postoperatively. Results Insulin level at 3-day after operation in group B was lower than that of the day before operation (P<0.05),while there was no significant difference between two groups. The levels of somatotropin, cortisol and CRP at 1-day after operation in group B were higher than that in group A. The REE level increased postoperatively, and the level in group B was higher than that in group A(P<0.05). Conclusions Compared with normal invasive surgery, micro invasive surgery on knee joint have less stress response and slight metabolic interference, which is of benefit to the restoration of stress hormones, nitrogen balance and energy metabolism.
