北京医学
北京醫學
북경의학
BEIJING MEDICAL JOURNAL
2014年
8期
629-631
,共3页
马子健%刘俊乐%徐娟%袁维秀
馬子健%劉俊樂%徐娟%袁維秀
마자건%류준악%서연%원유수
全身麻醉%全髋关节置换术%C反应蛋白%白细胞介素-6
全身痳醉%全髖關節置換術%C反應蛋白%白細胞介素-6
전신마취%전관관절치환술%C반응단백%백세포개소-6
Anesthesia%Total hip replacement%C reactive protein(CRP)%Interleukin-6(IL-6)
目的：探讨不同麻醉方法对单髋关节置换术患者C反应蛋白（CRP）及白细胞介素6（IL-6）变化的影响。方法39例择期行单侧全髋关节置换术患者，ASAⅠ~Ⅱ级，随机分为3组，每组13例，即全凭静脉麻醉组（TIVA组）、神经阻滞组（NB组）和硬膜外麻醉组（EA组），记录患者入室后、麻醉前、手术开始、手术结束各时点生命体征，及手术时间、术中输血量；于术前1 d，术后1、3、5、7 d抽取外周血，测定血清中CRP和IL-6水平。结果3组患者术中血流动力学稳定。3组患者CRP在术后第1天即出现明显升高，在术后第3天达峰值，术后第5、7天有所回落，与同组术前1 d比较，差异均有统计学意义（P<0.01），3组间各时点比较差异均无统计学意义（P>0.05）。3组患者IL-6在术后第1天即出现明显升高，并达峰值，术后第3、5、7天有所恢复，与同组术前1 d比较，差异均有统计学意义（P<0.01）；术后第1天NB组与TIVA组比较差异有统计学意义（P<0.05）。结论全凭静脉麻醉较神经阻滞和硬膜外麻醉可以减轻患者下肢手术过程中的应激反应。
目的：探討不同痳醉方法對單髖關節置換術患者C反應蛋白（CRP）及白細胞介素6（IL-6）變化的影響。方法39例擇期行單側全髖關節置換術患者，ASAⅠ~Ⅱ級，隨機分為3組，每組13例，即全憑靜脈痳醉組（TIVA組）、神經阻滯組（NB組）和硬膜外痳醉組（EA組），記錄患者入室後、痳醉前、手術開始、手術結束各時點生命體徵，及手術時間、術中輸血量；于術前1 d，術後1、3、5、7 d抽取外週血，測定血清中CRP和IL-6水平。結果3組患者術中血流動力學穩定。3組患者CRP在術後第1天即齣現明顯升高，在術後第3天達峰值，術後第5、7天有所迴落，與同組術前1 d比較，差異均有統計學意義（P<0.01），3組間各時點比較差異均無統計學意義（P>0.05）。3組患者IL-6在術後第1天即齣現明顯升高，併達峰值，術後第3、5、7天有所恢複，與同組術前1 d比較，差異均有統計學意義（P<0.01）；術後第1天NB組與TIVA組比較差異有統計學意義（P<0.05）。結論全憑靜脈痳醉較神經阻滯和硬膜外痳醉可以減輕患者下肢手術過程中的應激反應。
목적：탐토불동마취방법대단관관절치환술환자C반응단백（CRP）급백세포개소6（IL-6）변화적영향。방법39례택기행단측전관관절치환술환자，ASAⅠ~Ⅱ급，수궤분위3조，매조13례，즉전빙정맥마취조（TIVA조）、신경조체조（NB조）화경막외마취조（EA조），기록환자입실후、마취전、수술개시、수술결속각시점생명체정，급수술시간、술중수혈량；우술전1 d，술후1、3、5、7 d추취외주혈，측정혈청중CRP화IL-6수평。결과3조환자술중혈류동역학은정。3조환자CRP재술후제1천즉출현명현승고，재술후제3천체봉치，술후제5、7천유소회락，여동조술전1 d비교，차이균유통계학의의（P<0.01），3조간각시점비교차이균무통계학의의（P>0.05）。3조환자IL-6재술후제1천즉출현명현승고，병체봉치，술후제3、5、7천유소회복，여동조술전1 d비교，차이균유통계학의의（P<0.01）；술후제1천NB조여TIVA조비교차이유통계학의의（P<0.05）。결론전빙정맥마취교신경조체화경막외마취가이감경환자하지수술과정중적응격반응。
Objective To investigate the effect of three different anesthesia methods on serum C reactive protein (CRP) and interleukin-6 (IL-6) levels in the patients undergoing unilateral total hip replacement. Methods Thirty nine ASA Ⅰ~Ⅱ patients aged 22~63 years old were randomly divided into three groups: total intravenous anesthesia (TIVA group), nerve blockage(NB group) and epidural anesthesia( EA group). The HR, SBP, DBP, SpO2, the duration of operation and blood transfusion of patients in the three groups were recorded. The level of serum CRP and IL-6 was measured one the day before and 1, 3, 5, 7 d after operation. Results Hemodynamic indices of all cases were stable during the opera-tion. Compared to the day before operation, CRP and IL-6 in the three groups were significantly higher at 1, 3, 5, 7 d after operation respectively(P<0.01). In the TIVA group, the serum IL-6 was not significantly different compared with that be-fore operation (P>0.05), but obviously increased in NB group and EA group (P< 0.05). Compared to other groups at the same time, the extent of IL-6 in NB group was significantly higher at 1 d after operarion than that in TIVA group (P<0.05). Conclusion Surgery can lead to increased release of inflammatory cytokines, total intravenous anesthesia can more effectively reduce the stress response during operation in patients undergoing unilateral total hip replacement than nerve blocking and epidural anesthesia.
