CAJ | 학술논문

目的：探讨术前静脉注射羟乙基淀粉对老年胃癌根治手术患者血流动力学及炎症因子的影响。方法选取该院2011年10月至2013年12月老年胃癌根治手术患者156例，采用随机数字表法分为两组，78例患者术前静脉注射乳酸林格液为对照组，78例患者术前静脉注射羟乙基淀粉为观察组，比较两组患者不同时间点（静脉注射前T0、麻醉后5 min T1、麻醉后30 min T2、麻醉后60 min T3、手术结束时T4）血流动力学指标治疗前后凝血指标（凝血酶原时间、凝血酶时间、部分活化凝血活酶时间）、生化指标〔血红蛋白（ Hb）、血细胞比容（ Hct）、血小板（ Plt）计数〕、炎症因子〔肿瘤坏死因子（ TNF）α、干扰素（ IFN）γ、白细胞介素（ IL）－10〕的改变情况。结果对照组患者心率、平均动脉压在T1时均显著下降，而后逐渐增加；中心静脉压在T1时显著增加，而后逐渐降低。观察组患者心率、平均动脉压在T1、T2、T3、T4时均明显高于对照组，中心静脉压在T1、T2、T3、T4时明显低于对照组。治疗后，两组患者凝血酶原时间、凝血酶时间均显著增加。观察组患者 Hb、Hct、Plt、TNFα、IFNγ和 IL－10水平均显著降低， Plt、TNFα、IFNγ和IL－10水平均明显低于对照组、部分活化凝血活酶时间明显高于对照组（ P＜0．05）。结论术前静脉注射羟乙基淀粉有助于稳定老年胃癌根治手术患者的血流动力学指标，显著降低炎症因子水平。
목적：탐토술전정맥주사간을기정분대노년위암근치수술환자혈류동역학급염증인자적영향。방법선취해원2011년10월지2013년12월노년위암근치수술환자156례，채용수궤수자표법분위량조，78례환자술전정맥주사유산림격액위대조조，78례환자술전정맥주사간을기정분위관찰조，비교량조환자불동시간점（정맥주사전T0、마취후5 min T1、마취후30 min T2、마취후60 min T3、수술결속시T4）혈류동역학지표치료전후응혈지표（응혈매원시간、응혈매시간、부분활화응혈활매시간）、생화지표〔혈홍단백（ Hb）、혈세포비용（ Hct）、혈소판（ Plt）계수〕、염증인자〔종류배사인자（ TNF）α、간우소（ IFN）γ、백세포개소（ IL）－10〕적개변정황。결과대조조환자심솔、평균동맥압재T1시균현저하강，이후축점증가；중심정맥압재T1시현저증가，이후축점강저。관찰조환자심솔、평균동맥압재T1、T2、T3、T4시균명현고우대조조，중심정맥압재T1、T2、T3、T4시명현저우대조조。치료후，량조환자응혈매원시간、응혈매시간균현저증가。관찰조환자 Hb、Hct、Plt、TNFα、IFNγ화 IL－10수평균현저강저， Plt、TNFα、IFNγ화IL－10수평균명현저우대조조、부분활화응혈활매시간명현고우대조조（ P＜0．05）。결론술전정맥주사간을기정분유조우은정노년위암근치수술환자적혈류동역학지표，현저강저염증인자수평。
Objective To investigate the effect of hemodynamics and inflammatory factors in elderly patients with gastric cancer rad -ical operation by preoperative intravenous hydroxyethyl starch .Methods 156 elderly patients with gastric cancer radical operation were ran-domly divided into two groups ,78 patients treated with preoperative intravenous injection of ringer lactate solution were as control group ,78 patients treated with preoperative intravenous hydroxyethyl starch as observation group .The changes of hemodynamic parameters〔heart rate (HR),mean arterial pressure(MAP),central venous pressure(CVP)〕at different time points (before intravenous injection T0,after anesthe-sia 5 min T1,after anesthesia 30 min T2,after anesthesia 60 min T3,at the end of operation T4),the changes of coagulation indexes (pro-thrombin time;thrombin time;activated partial thromboplastin time );changes of biochemical indexes〔hemoglobin(Hb),hematocrit(Hct), platelet(Plt)count〕;changes of inflammatory cytokines〔TNF-α,interferon(IFN)-γ,interleukin(IL)-10〕were compared between two groups before and after treatment .Results HR and MAP were decreased significantly at T1 and then increased in control group.CVP was increased significantly at T1 and then decreased in control group .HR and MAP at T1,T2,T3,T4 in observation group were significantly higher than those of control group.CVP at T1,T2,T3,T4 in observation group were significantly lower than those of control group .After treatment,pro-thrombin time and thrombin time were increased significantly in two groups ,the levels of Hb,Hct,Plt count,TNFα,IFNγ,IL-10 were de-creased significantly in observation group ,and they were significantly lower than those of control group .Activated partial thromboplastin time in observation group was significantly higher than that of control group (P<0.05).Conclusions Preoperative intravenous hydroxyethyl starch is helpful to stabilize hemodynamics of elderly patients with gastric cancer radical operation ,which could significantly decrease levels of in-flammatory factors.