CAJ | 학술논문

目的：观察氧化亚氮（N2O）对高强度聚焦超声（HIFU）治疗患者血清游离血红蛋白（FHb）及细胞间黏附分子1（ICAM‐1）含量的影响，探讨其组织损伤的作用机制。方法将50例原发性肝癌行HIFU治疗的患者（ASAⅠ～Ⅱ级），分为对照组（C组）与试验组（N组），每组25例。两组均使用全身麻醉方式，C组采用全凭静脉麻醉，N组采用静吸复合麻醉，两组麻醉诱导方式相同，N组麻醉维持在C组基础上吸入N2 O。分别在麻醉前（T1）、手术前（T2）、术中第1小时（T3）、第2小时（T4）、第3小时（T5），及术后24 h（T6）抽取桡动脉血，采用类过氧化物酶反应法和双抗体夹心ELISA法检测血清中FHb及ICAM‐1含量；用HIFU治疗仪超声显像系统测量两组患者术前、术后腹壁厚度值。结果随着手术过程中麻醉时间的延长，血清中 FHb及ICAM‐1含量之较前均明显增多（P＜0．05）；同一时间点，与C组相比，N组FHb和ICAM‐1增多明显（P＜0．05）；与C组相比，N组术前、术后腹壁厚度值变化明显增加（P＜0．05）。结论 N组在 HIFU治疗过程中，机体产生更多的 FHb及ICAM‐1，继发引起腹壁皮肤明显肿胀，这可能与N2 O增强超声空化效应有关。
목적：관찰양화아담（N2O）대고강도취초초성（HIFU）치료환자혈청유리혈홍단백（FHb）급세포간점부분자1（ICAM‐1）함량적영향，탐토기조직손상적작용궤제。방법장50례원발성간암행HIFU치료적환자（ASAⅠ～Ⅱ급），분위대조조（C조）여시험조（N조），매조25례。량조균사용전신마취방식，C조채용전빙정맥마취，N조채용정흡복합마취，량조마취유도방식상동，N조마취유지재C조기출상흡입N2 O。분별재마취전（T1）、수술전（T2）、술중제1소시（T3）、제2소시（T4）、제3소시（T5），급술후24 h（T6）추취뇨동맥혈，채용류과양화물매반응법화쌍항체협심ELISA법검측혈청중FHb급ICAM‐1함량；용HIFU치료의초성현상계통측량량조환자술전、술후복벽후도치。결과수착수술과정중마취시간적연장，혈청중 FHb급ICAM‐1함량지교전균명현증다（P＜0．05）；동일시간점，여C조상비，N조FHb화ICAM‐1증다명현（P＜0．05）；여C조상비，N조술전、술후복벽후도치변화명현증가（P＜0．05）。결론 N조재 HIFU치료과정중，궤체산생경다적 FHb급ICAM‐1，계발인기복벽피부명현종창，저가능여N2 O증강초성공화효응유관。
Objective To observe the effect of nitrous oxide (N2O) on the content of serum free hemoglobin ,and intercellular adhesion molecule‐1 (ICAM‐1) of patients with HIFU Therapy ,and investigate its action of tissue damage mechanism .Methods 50 patients with primary liver cancer undergoing HIFU surgery (ASA Ⅰ - Ⅱ class) were randomly divided into control group (group C) and experimental group(group N) ,25 patients of each group .General anesthesia method was used in both two groups , group C was by total intravenous anesthesia ,group N was adopted intravenous‐inhalation anesthesia .both two groups was adopted the same anesthesia induction method .anesthesia maintain of group N was joined N2 O on the basis of group C .both two groups were draw blood from the radial artery at the points of before anesthesia (T1 ) ,before operation (T2 ) ,1 h (T3 ) ,2 h (T4 ) ,3 h (T5 ) after intraoperative ,and 24 h after operation (T6 ) ,peroxidase reaction test and double antibody sandwich ELISA method were a‐dopted to detect the content of Fhb value and ICAM‐1 ;ultrasonography system of HIFU therapeutic instrument was used to meas‐ure the abdominal wall thickness of patients before and after operation .Results The content of FHb and ICAM‐1 in serum were significantly increased after operation than before with the anesthesia time (P<0 .05);compared with group C ,group N increased obviously at the same point in time (P<0 .05);preoperative and postoperative abdominal wall thickness value of group N was in‐creased significantly (P< 0 .05) .Conclusion It may be connected with N2 O enhanced ultrasound cavitation effect that the body produces more FHb and ICAM‐1 of group N in HIFU treatment ,and induces abdominal wall skin markedly swollen .