CAJ | 학술논문

目的观察老年患者胆囊切除术围手术期血浆内皮素和降钙素基因相关肽(CGRP)水平的变化,了解内皮素和CGRP在老年患者手术麻醉应激反应中的作用.方法选取择期行胆囊切除术的患者60例,根据年龄分为实验组和对照组,其中,实验组年龄＞65岁,平均年龄(44±17)岁;对照组年龄＜65岁,平均年龄(7l±5)岁,两组病例数均为30例.分别于手术麻醉前(T0期)、气管插管后(T1期)、胆囊切除时(T2期)、术毕(T3期)、术后24h(T4期)抽取静脉血,采用放射免疫分析法测定血浆中内皮素和CGRP水平.结果 T0期实验组血浆中内皮素水平高于对照组,但两组间比较差异无统计学意义(t=0.971,P＞0.05);T1期两组患者血浆中内皮素水平均逐渐升高,其中实验组增高明显(t=4.258,P＜0.05);T2期两组患者血浆中内皮素水平继续升高,实验组增高明显(t=5.134,P＜0.01);T3期对照组患者血浆内皮素水平开始降低,而实验组患者内皮素水平继续升高(t=6.627,P＜0.01);T4期两组患者内皮素水平均恢复到T0期水平,两组间比较差异无统计学意义(t=1.917,P＞0.05).对照组患者血浆CGRP水平在围手术期变化不明显,而实验组患者血浆中CGRP水平在T0期后降低,T2期又逐渐增高,到T3期达到最高.两组患者在T1期和T3期的CGRP水平相比,差异有统计学意义(t=4.084和t=4.085,P均＜0.05).结论老年患者胆囊切除术围手术期内皮素和CGRP水平变化均较青壮年患者显著,内皮素的变化尤为明显,围手术期危险更大.
목적 관찰노년환자담낭절제술위수술기혈장내피소화강개소기인상관태(CGRP)수평적변화,료해내피소화CGRP재노년환자수술마취응격반응중적작용.방법 선취택기행담낭절제술적환자60례,근거년령분위실험조화대조조,기중,실험조년령＞65세,평균년령(44±17)세;대조조년령＜65세,평균년령(7l±5)세,량조병례수균위30례.분별우수술마취전(T0기)、기관삽관후(T1기)、담낭절제시(T2기)、술필(T3기)、술후24h(T4기)추취정맥혈,채용방사면역분석법측정혈장중내피소화CGRP수평.결과 T0기실험조혈장중내피소수평고우대조조,단량조간비교차이무통계학의의(t=0.971,P＞0.05);T1기량조환자혈장중내피소수평균축점승고,기중실험조증고명현(t=4.258,P＜0.05);T2기량조환자혈장중내피소수평계속승고,실험조증고명현(t=5.134,P＜0.01);T3기대조조환자혈장내피소수평개시강저,이실험조환자내피소수평계속승고(t=6.627,P＜0.01);T4기량조환자내피소수평균회복도T0기수평,량조간비교차이무통계학의의(t=1.917,P＞0.05).대조조환자혈장CGRP수평재위수술기변화불명현,이실험조환자혈장중CGRP수평재T0기후강저,T2기우축점증고,도T3기체도최고.량조환자재T1기화T3기적CGRP수평상비,차이유통계학의의(t=4.084화t=4.085,P균＜0.05).결론 노년환자담낭절제술위수술기내피소화CGRP수평변화균교청장년환자현저,내피소적변화우위명현,위수술기위험경대.
Objective To investigate the effects of laparoscopic cholecystectomy on the plasma levels of endothelin and calcitonin gene-related peptide (CGRP)in elderly patients. Methods Sixty patients undergoing elective laoaroscopic cholecystectomy were divided into ＜65 years old group and ＞65 years old group according to their ages (30 cases in each group). The plasma levels of endothelin and CGRP were measured before surgery, after intubation, at the time of gallbladder removal, immediately after surgery and 24 hours after surgery by radioimmunoassay. Results There was no significant difference in endothelin levels between the two groups before the surgery (t=0.971, P＞0.05). The endothelin levels in both groups gradually increased after the intubation, but more significantly in the ＞ 65 years old group (t=4.258, P＜0.05). The increased endothelin levels were maintained during the surgery in both groups, but they were higher in the ＞65years old group (t=5.134,P＜0.01 ). When the surgery was completed, the level of endothelin in the ＞65 years old group continued to increase, but it decreased in the ＜65 years old group, and there was significantly difference between the two groups(t=6.627, P＜0.01 ). Endothelin levels in both groups at 24 hours after the surgery returned to the levels before surgery, and there was no significant difference between the two groups (t=1.917, P＞0.05). The CGRP levels had not significantly changed during the perioperative period in the ＜65 years old group. In the ＞65 years old group, CGRP levels decreased after anaesthesia, but increased during the surgery, and then reached the highest level at the time of the surgery completed. CGRP levels were significant difference between the two groups after intubation and immediately after surgery (t=4.084 and t=4.085, P＜0.05). Conclusion The levels of endothelin and CGRP had significantly changed elderly patients than those in young patients, especially for endothelin.