浙江中西医结合杂志
浙江中西醫結閤雜誌
절강중서의결합잡지
ZHEJIANG JOURNAL OF INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE
2015年
4期
327-330
,共4页
倪剑武%谷志飞%胡一迪%蔡文品%蒋柳明%张学政
倪劍武%穀誌飛%鬍一迪%蔡文品%蔣柳明%張學政
예검무%곡지비%호일적%채문품%장류명%장학정
肠癌%手术时间%胃肠功能%时钟节律%褪黑素%炎症反应
腸癌%手術時間%胃腸功能%時鐘節律%褪黑素%炎癥反應
장암%수술시간%위장공능%시종절률%퇴흑소%염증반응
Colorectal cancer%Operation time%Gastrointestinal function%Circadian rhythm%Melatonin%Inflamma-tion reaction
目的：观察一天中不同时间进行肠道手术对患者术后胃肠功能恢复和炎症反应的影响，并探讨褪黑素在其中的作用。方法选择75例择期开腹行结直肠癌根治术患者，根据手术开始时间分为三组，CT1（8：00~14：00）和CT2组（14：00~20：00）患者各30例，CT3组（20：00~2：00）患者15例，三组患者均选择全凭静脉麻醉。在围术期不同时点抽取患者外周血检测褪黑素、C反应蛋白（CRP）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平，同时观察患者术后胃肠道功能恢复情况及术后并发症发生率。结果 CT3组患者麻醉前即刻褪黑素水平比手术即日晨8点明显升高[（23.46±4.13）pg/mL比（16.73±3.77）pg/mL，P<0.05]，且明显高于CT1组[（16.30±3.73）pg/mL]及CT2组[（15.75±3.54）pg/mL]麻醉前即刻（P<0.05）；CT3组术后肛门排气时间[（73.2±6.3）h]、排便时间[（95.6±8.3）h]、胃液引流量[（452.3±93.7）mL]均明显高于CT1组[（66.7±5.6）h、（8.75±7.4）h、（310.4±78.9）mL]及CT2组[（65.3±6.2）h、（86.7±6.8）h、（307.5±80.1）mL]（P<0.05），CT3组术后感染发生率明显高于CT1组及CT2组（53.3%比16.7%、20.0%，P<0.05）；CT3组患者术后1、3天的CRP、IL-6、TNF-α水平明显高于CT1组及CT2组[术后1天CRP：（95.6±16.9）mg/L比（78.8±16.4） mg/L、（80.3±15.7）mg/L；IL-6：（124.7±26.9）pg/L比（104.5±24.3）pg/L、（107.5±22.8）pg/L；TNF-α：（379.8±94.6）pg/L比（317.5±83.1）pg/L、（313.2±86.4）pg/L。术后3天CRP：（78.8±15.4）mg/L比（66.3±12.9）mg/L、（67.6±13.5）mg/L；IL-6：（106.3±22.5）pg/L比（92.7±20.4）pg/L、（93.2±21.0）pg/L；TNF-α：（294.3±78.7）pg/L比（244.9±72.0）pg/L、（245.7±71.6）pg/L，P<0.05]。结论同一天中不同时间进行肠癌手术会影响手术预后，晚上进行的肠道手术术后炎症反应较强，术后胃肠功能恢复较慢，术后感染发生率较高，其原因可能与褪黑素对时钟节律的调节有关。
目的：觀察一天中不同時間進行腸道手術對患者術後胃腸功能恢複和炎癥反應的影響，併探討褪黑素在其中的作用。方法選擇75例擇期開腹行結直腸癌根治術患者，根據手術開始時間分為三組，CT1（8：00~14：00）和CT2組（14：00~20：00）患者各30例，CT3組（20：00~2：00）患者15例，三組患者均選擇全憑靜脈痳醉。在圍術期不同時點抽取患者外週血檢測褪黑素、C反應蛋白（CRP）、白介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）水平，同時觀察患者術後胃腸道功能恢複情況及術後併髮癥髮生率。結果 CT3組患者痳醉前即刻褪黑素水平比手術即日晨8點明顯升高[（23.46±4.13）pg/mL比（16.73±3.77）pg/mL，P<0.05]，且明顯高于CT1組[（16.30±3.73）pg/mL]及CT2組[（15.75±3.54）pg/mL]痳醉前即刻（P<0.05）；CT3組術後肛門排氣時間[（73.2±6.3）h]、排便時間[（95.6±8.3）h]、胃液引流量[（452.3±93.7）mL]均明顯高于CT1組[（66.7±5.6）h、（8.75±7.4）h、（310.4±78.9）mL]及CT2組[（65.3±6.2）h、（86.7±6.8）h、（307.5±80.1）mL]（P<0.05），CT3組術後感染髮生率明顯高于CT1組及CT2組（53.3%比16.7%、20.0%，P<0.05）；CT3組患者術後1、3天的CRP、IL-6、TNF-α水平明顯高于CT1組及CT2組[術後1天CRP：（95.6±16.9）mg/L比（78.8±16.4） mg/L、（80.3±15.7）mg/L；IL-6：（124.7±26.9）pg/L比（104.5±24.3）pg/L、（107.5±22.8）pg/L；TNF-α：（379.8±94.6）pg/L比（317.5±83.1）pg/L、（313.2±86.4）pg/L。術後3天CRP：（78.8±15.4）mg/L比（66.3±12.9）mg/L、（67.6±13.5）mg/L；IL-6：（106.3±22.5）pg/L比（92.7±20.4）pg/L、（93.2±21.0）pg/L；TNF-α：（294.3±78.7）pg/L比（244.9±72.0）pg/L、（245.7±71.6）pg/L，P<0.05]。結論同一天中不同時間進行腸癌手術會影響手術預後，晚上進行的腸道手術術後炎癥反應較彊，術後胃腸功能恢複較慢，術後感染髮生率較高，其原因可能與褪黑素對時鐘節律的調節有關。
목적：관찰일천중불동시간진행장도수술대환자술후위장공능회복화염증반응적영향，병탐토퇴흑소재기중적작용。방법선택75례택기개복행결직장암근치술환자，근거수술개시시간분위삼조，CT1（8：00~14：00）화CT2조（14：00~20：00）환자각30례，CT3조（20：00~2：00）환자15례，삼조환자균선택전빙정맥마취。재위술기불동시점추취환자외주혈검측퇴흑소、C반응단백（CRP）、백개소-6（IL-6）、종류배사인자-α（TNF-α）수평，동시관찰환자술후위장도공능회복정황급술후병발증발생솔。결과 CT3조환자마취전즉각퇴흑소수평비수술즉일신8점명현승고[（23.46±4.13）pg/mL비（16.73±3.77）pg/mL，P<0.05]，차명현고우CT1조[（16.30±3.73）pg/mL]급CT2조[（15.75±3.54）pg/mL]마취전즉각（P<0.05）；CT3조술후항문배기시간[（73.2±6.3）h]、배편시간[（95.6±8.3）h]、위액인류량[（452.3±93.7）mL]균명현고우CT1조[（66.7±5.6）h、（8.75±7.4）h、（310.4±78.9）mL]급CT2조[（65.3±6.2）h、（86.7±6.8）h、（307.5±80.1）mL]（P<0.05），CT3조술후감염발생솔명현고우CT1조급CT2조（53.3%비16.7%、20.0%，P<0.05）；CT3조환자술후1、3천적CRP、IL-6、TNF-α수평명현고우CT1조급CT2조[술후1천CRP：（95.6±16.9）mg/L비（78.8±16.4） mg/L、（80.3±15.7）mg/L；IL-6：（124.7±26.9）pg/L비（104.5±24.3）pg/L、（107.5±22.8）pg/L；TNF-α：（379.8±94.6）pg/L비（317.5±83.1）pg/L、（313.2±86.4）pg/L。술후3천CRP：（78.8±15.4）mg/L비（66.3±12.9）mg/L、（67.6±13.5）mg/L；IL-6：（106.3±22.5）pg/L비（92.7±20.4）pg/L、（93.2±21.0）pg/L；TNF-α：（294.3±78.7）pg/L비（244.9±72.0）pg/L、（245.7±71.6）pg/L，P<0.05]。결론동일천중불동시간진행장암수술회영향수술예후，만상진행적장도수술술후염증반응교강，술후위장공능회복교만，술후감염발생솔교고，기원인가능여퇴흑소대시종절률적조절유관。
Objective To investigate the effect of circadian rhythm on recovery of gastrointestinal function and inflammatory reaction after surgery for colorectal cancer at different time in one day, and to explore the role of melatonin in it. Methods A total of 75 patients undergoing selective surgery for colorectal cancer were enrolled. They were divided into CT1(8:00~14:00) group(n=30), CT2(14:00~20:00) group(n=30), and CT3(20:00~2:00) group(n=15) according to the operation time. All patients underwent total intravenous anesthesia. The levels of melatonin, C reactive protein(CRP), interleukin-6(IL-6), tumor necrosis factor alpha(TNF-α) in peripheral blood of patients were detected at different perioperative time points. The recovery of gastrointestinal function and the in-cidence of complications were observed after operation. Results Melatonin levels immediately before anesthesia in CT3 group were significantly higher than those at 8:00 of operation day(23.46±4.13pg/mL vs 16.73±3.77pg/mL, P<0.05) and those immediately before anesthesia in other two groups(CT1:16.30±3.73pg/mL; CT2:15.75±3.54pg/mL;all P<0.05). Anal exhaust time(73.2±6.3h), time of defecation(95.6±8.3h), gastric drainage volume(452.3±93.7mL)of patients in CT3 group were significantly longer or larger than those in other two groups [CT1:66.7±5.6h, 8.75±7.4h, 310.4±78.9mL; CT2:65.3±6.2h, 86.7±6.8h, 307.5±80.1mL; all P<0.05]. In CT3 group, the incidence of infec-tion (53.3% vs 16.7%, 20.0%, P<0.05) and the levels of CRP, IL-6, TNF-α of patients on postoperative day 1 and day 3 were significantly higher than that in other two group (Day 1 CRP:95.6±16.9mg/L vs 78.8±16.4mg/L, 80.3±15.7mg/L; Day 1 IL-6:124.7±26.9pg/L vs 10.5±24.3pg/L, 107.5±22.8pg/L; Day 1 TNF-α:379.8±94.6pg/L vs 317.5±83.1pg/L, 313.2±86.4pg/L; Day 3 CRP:78.8±15.4mg/L vs 66.3±12.9mg/L, 67.6±13.5mg/L; Day 3 IL-6:106.3±22.5pg/L vs 92.7±20.4pg/L, 93.2±21.0pg/L; Day 3 TNF-α:294.3±78.7pg/L vs 244.9±72.0pg/L, 245.7±71.6pg/L; all P<0.05). Conclusion The operation time of colorectal cancer surgery will affect the prognosis of patients. Under-going the surgery at night will cause stronger inflammation reaction and delay the recovery of gastrointestinal func-tion and have higher incidence of complications. These effect may be related to the regulation of circadian rhythm by melatonin.
