腰硬联合麻醉和全身麻醉对老年髋部手术患者肠道黏膜通透性的影响被引量：4

Effect of combined spinal epidural anesthesia and general anesthesia on intestinal mucosal permeability in elderly patients undergoing hip surgery

原文传递

导出

摘要目的探讨不同麻醉方法对老年髋部手术患者肠道黏膜通透性改变的影响。方法 41例全髋或半髋手术患者随机分配进入腰硬联合麻醉组(L组,n=18)和喉罩通气全身麻醉组(Q组,n=23),留取术前(T0,基础值)、手术开始后1 h(T1)、2 h(T2)和手术结束后2 h(T3)、6 h(T4)、18 h(T5)血样(颈内静脉穿刺并采血),分别检测肠道黏膜损伤特异性指标:肠型脂肪酸结合蛋白(I-FABP)、D-乳酸以及炎性指标白细胞介素-6(IL-6)。统计术后相关并发症及预后。结果两组患者术中、术后IL-6呈持续升高的趋势,在T4~T5时达到峰值[(109.44±99.11)pg/ml],T2~T5时较T0时[(5.85±5.72)pg/ml]均明显升高,差异有统计学意义(P<0.01),但组间比较差异无统计学意义(P>0.05);共有35例完成完整的I-FABP数据采集和检测,发现术前、术中均有I-FABP浓度异常波动,其中19例T0时I-FABP≥1.0 ng/L,24例T1~T5时出现血浆I-FABP浓度明显升高(超过基础值浓度1倍);Q组T5时血浆I-FABP浓度[(2.906±2.813)ng/L]较T0时[(1.432±1.114)ng/L]明显升高,差异有统计学意义(t=2.067,P<0.05),Q组T5时血浆I-FABP浓度[(2.906±2.813)ng/L]较L组[(0.927±0.873)ng/L]明显升高,差异有统计学意义(t=2.765,P<0.01)。6例术中D-乳酸异常升高(超过基础值1倍),其中4例伴有I-FABP浓度剧烈改变(>5.0 ng/L,最高10.0 ng/L)。结论在老年髋部手术中存在肠道黏膜通透性改变的客观依据,部分患者术前就存在肠道黏膜通透性改变;两种麻醉方式对于老年髋部手术术中炎性反应的影响无明显差别。与腰硬联合麻醉比较,全身麻醉下行髋部手术的老年患者术后血浆I-FABP浓度持续升高,发生肠道黏膜通透性改变的风险增加。 Objective To investigate the effect of different anesthesia methods on intestinal permeability changes in elderly patients with hip surgery. Methods 41 cases of total hip and half of the hip surgery were randomly assigned to the combined spinal epidural anesthesia group(group L, n=18) and laryngeal mask airway ventilation group(group Q, n=23). Blood samples were collected at the time points: before surgery(T0), 1 hours(T1) or 2 hours(T2) after the start of the operation, 2 hours(T3), 6 hours(T4) or 18 hours(T5) after the operation. Then the specific indexes of intestinal mucosa injury(intestinal fatty acid binding protein; D-lactic acid) and inflammatory index interleukin-6 were detected. Postoperative complications and prognosis were analyzed statistically. Results The two groups of patients with postoperative IL-6 showed a trend of continuous elevation, when T4-T5 reached the peak(109.44±99.11)pg/ml, T2-T5 was significantly higher than T0(5.85±5.72)pg/ml, there were statistically significant differences(P<0.01), but there was no statistical difference between two groups(P>0.05). The abnormal fluctuation of I-FABP concentration was found before or during the operation. Within 35 patients with complete data I-FABP, 19 patients before operation(T0) I-FABP was more than or equal to 1.0 ng/L; and compared with T0, 24 patients in the T1 to T5 time plasma I-FABP concentrations increased by more than 1 time; In Q group, I-FABP concentrations at T5 was significantly higher than those at T0[(2.906±2.813)ng/L vs.(1.432±1.114)ng/L]. There was significant difference(t=2.067, P<0.05) and in Q group I-FABP concentrations at T5 was increased significantly than those in the L group [(2.906±2.813)ng/L vs.(0.927±0.873)ng/L], there were significant differences(t=2.765, P<0.01). Found 6 cases of patients with abnormal increase in concentration of D-lactic acid(more than 1 time the basic value), which including 4 patients with severe changes in the concentration of I-FABP(values over 5.0 ng/L, the highest 10.0 ng/L). Conclusio