摘要
目的:观察腹腔镜手术患者全身麻醉中应用羟考酮对血管内皮损伤的影响。方法:选取上海交通大学医学院附属新华医院崇明分院2018年9月至2019年9月行腹腔镜手术患者80例为观察对象,采用随机数字表法将患者分为对照组和观察组,每组40例。对照组于气腹开始前静脉注射0.9%氯化钠注射液10 mL,观察组静脉注射盐酸羟考酮10 mg。于气腹开始前(基础值,T0)、气腹后1 h(T_(1))、气腹后2 h(T_(2))、气腹结束时(T_(3))和术后24 h(T_(4))测定两组去甲肾上腺素(NE)、肾上腺素(E)、血清硫酸肝素(HS)、多配体蛋白聚糖1抗体(DPT-1)和血管细胞黏附分子1(VCAM-1)浓度。记录两组手术时间、气腹时间、出血量。观察两组并发症(心律失常、高血压、烦躁、瘙痒、术后恶心呕吐等)发生情况,比较两组术后视觉模拟评分法(VSA)评分。 结果:与T 0时比较,两组在T_(3)、T_(4)时HS、DPT-1、VCAM-1均明显升高,差异均有统计学意义(均 P<0.05);观察组HS[(15.7±4.8)μg/L]、DPT-1[(31.5±6.4)μg/L]、VCAM-1[(609.7±90.4)μg/L]在T_(4)时较对照组[(18.6±5.4)μg/L、(36.9±7.3)μg/L、(653.2±91.8)μg/L]均明显降低,差异均有统计学意义( t=2.539、3.518、2.135,均 P<0.05)。与T 0时比较,两组在T_(2)、T_(3)时NE、E均明显升高,差异均有统计学意义(均 P<0.05);观察组NE[(124.6±14.5)μg/L)]、E[(106.4±11.5)μg/L)在T_(2)时均较对照组[(132.9±12.4)μg/L、(111.8±10.4)μg/L]明显降低,差异均有统计学意义( t=2.751、2.203,均 P<0.05)。观察组术后烦躁发生率及VSA评分均低对照组(均 P<0.05)。 结论:在腹腔镜手术患者气腹前予盐酸羟考酮10 mg静脉注射有利于抑制炎性反应,降低腹腔镜手术因气腹导致的内皮糖萼降解,减少血管内皮损伤,该研究有创新性和科学性。
Objective To investigate the effects of oxycodone on vascular endothelial injury in patients undergoing laparoscopic surgery under general anesthesia.Methods Eighty patients who received laparoscopic surgery in Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,China between September 2018 and September 2019 were included in this study.They were randomly assigned to undergo either intravenous administration of 10 mL 0.9%sodium chloride injection(control group,n=40)or intravenous administration of 10 mg oxycodone hydrochloride before pneumoperitoneum(observation group,n=40).Serum levels of norepinephrine(NE),epinephrine(E),heparin sulfate(HS),DPT-1 and vascular cell adhesion molecule-1(VCAM-1)were measured in each group before pneumoperitoneum(baseline,T0),at 1 hour after pneumoperitoneum(T_(1)),2 hours after pneumoperitoneum(T_(2)),at the end of pneumoperitoneum(T_(3))and at 24 hours after surgery(T_(4)).Operative time,pneumoperitoneum time and blood loss were recorded in both groups.The incidence of complications(arrhythmia,hypertension,irritability,pruritus,postoperative nausea and vomiting)was recorded.Postoperative Visual Analogue Scale score was compared between the observation and control groups.Results At T_(3) and T_(4),serum levels of HS,DPT-1 and VCAM-1 in each group were significantly increased compared with T0(all P<0.05).At T_(4),serum levels of HS,DPT-1,and VCAM-1 in the observation group were(15.7±4.8)μg/L,(31.5±6.4)μg/L and(609.7±90.4)μg/L,respectively,which were significantly lower than those in the control group[(18.6±5.4)μg/L,(36.9±7.3)μg/L,(653.2±91.8)μg/L,t=2.539,3.518,2.135,all P<0.05].At T_(2) and T_(3),serum levels of NE and E in each group were significantly increased compared with T0(all P<0.05).At T_(2),serum levels of NE and E in the observation group were(124.6±14.5)μg/L and(106.4±11.5)μg/L,respectively,which were significantly lower than those in the control group[(132.9±12.4)μg/L,(111.8±10.4)μg/L,t=2.751,2.203,both
作者
李辉
季惠
黄翠凤
Li Hui;Ji Hui;Huang Cuifeng(Department of Anesthesiology,Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 202150,China)
出处
《中国基层医药》
CAS
2021年第8期1145-1149,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
麻醉
全身
腹腔镜
外科手术
气腹
人工
内皮
血管
抑制
应激
炎症
外被体蛋白
Anesthesia,general
Laparoscopes
Surgical procedures,operative
Pneumoperitoneum,artificial
Endothelium,vascular
Suppressor
Stress
Inflammation
Coatomer protein
