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      标题:艾司洛尔对腹腔镜胃肠癌根治术患者免疫应激及血流动力学的影响
      作者:唐韬,李婧    (泸州市中医医院麻醉科,四川 泸州 646000)
      卷次: 2018年29卷10期
      【摘要】 目的 探讨老年腹腔镜胃肠癌根治术患者术中持续泵注艾司洛尔对患者血流动力学和免疫应激指标的影响。方法 选取泸州市中医医院2015年8月至2017年3月收治的112例拟实施老年腹腔镜胃肠癌根治术患者,采用随机数表法分为观察组和对照组各56例,观察组于插管前3 min静注艾司洛尔0.3 mg/kg,术中持续泵注艾司洛尔50 μg/(kg·min)至气管拔管,对照组给予等量生理盐水。监测并对比两组患者麻醉诱导前(T0)、气管插管后(T1)、手术结束时(T2)、拔管即刻(T3)、拔管后30 min (T4)的平均动脉压(MAP)、心率(HR)、呼吸频率(RR);对比两组患者麻醉诱导前、术毕、术后 24 h的血清白细胞介素-4 (IL-4)、IL-6、γ-干扰素(INF-γ)、肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DA)的水平。结果 在T1、T2时刻观察组患者的MAP分别为(94.8±7.3) mmHg (1 mmHg=0.133 kPa)、(94.8±7.3) mmHg,均明显高于对照组的(83.2±7.7) mmHg、(84.7±6.9) mmHg,而在T3时刻为(91.7±5.8) mmHg,明显低于对照组的(96.0±7.2) mmHg,差异均有统计学意义(P<0.05);T1、T2、T3时刻观察组患者的HR、RR值均明显低于对照组,差异均有统计学意义(P<0.05);在术毕、术后24 h,观察组患者的 IL-4、IL-6、E、NE、DA测定值均明显低于对照组,而 INF-γ测定值均明显高于对照组,差异均有统计学意义(P<0.05)。结论 老年腹腔镜胃肠癌根治术患者术中持续泵注艾司洛尔有利于维持术中血流稳定性、降低应激反应程度及免疫损伤。
      【关键词】 老年;腹腔镜胃肠癌根治术;艾司洛尔;血流动力学;免疫应激
      【中图分类号】 R735 【文献标识码】 A 【文章编号】 1003—6350(2018)10—1369—04
Effects of esmolol on immune stress and hemodynamics in patients with gastrointestinal cancer undergoinglaparoscopic radical gastrectomy. TANG Tao, LI Jing. Department of Anesthesiology, Luzhou Hospital of TraditionalChinese Medicine, Luzhou 646000, Sichuan, CHINA
      【Abstract】 Objective To investigate the effect of continuous infusion of esmolol on hemodynamics and im-mune stress in elderly patients with gastrointestinal cancer undergoing laparoscopic radical gastrectomy. Methods Atotal of 112 patients who underwent laparoscopic radical gastrectomy were enrolled in Luzhou Hospital of TraditionalChinese Medicine from August 2015 to March 2017. They were divided into observation group and control group accrod-ing to random number table, with 56 patients in each group. The observation group received intravenous injection of es-molol 0.3 mg/kg 3 minutes before intubation and continuous infusion of esmolol 50 μg/(kg·min) during operation to tra-cheal extubation, while the control group were given the same amount of saline. The mean arterial pressure (MAP), heartrate (HR) and respiratory rate (RR) of the two groups were monitored and compared before anesthesia induction (T0), af-ter tracheal intubation (T1), at the end of surgery (T2), immediately after extubation (T3) and 30 minutes after extubation(T4). The levels of serum interleukin-4 (IL-4), interleukin-6 (IL-6), interferon-γ (INF-γ), epinephrine (E), norepineph-rine (NE), dopamine (DA) were compared before anesthesia induction, at the end of surgery, and 24 h after the opera-tion. Results The MAP of the observation group was (94.8±7.3) mmHg and (94.8±7.3) mmHg at T1 and T2, whichwere significantly higher than (83.2±7.7) mmHg and (84.7±6.9) mmHg of the control group (P<0.05), respectively. TheMAP of the observation group was (91.7±5.8) mmHg at T3, which was significantly lower than (96.0±7.2) mmHg of thecontrol group (P<0.05). The HR and RR of patients in the observation group at T1, T2, and T3 were significantly lowerthan those in the control group, with statistically significant differences (P<0.05). At the end of surgery and 24 hours af-ter operation, the levels of IL-4, IL-6, E, NE, and DA in the observation group were significantly lower than those in thecontrol group. However, the INF-γ value in the observation group was significantly higher than that in the controlgroup, with statistically significant difference (P<0.05). Conclusion Continuous infusion of esmolol during laparoscop-ic radical resection of gastrointestinal cancer in elderly patients is conducive to maintaining intraoperative blood flow sta-bility, reduce the degree of stress response and immune injury.
      【Key words】 Elderly; Laparoscopic radical gastrectomy; Esmolol; Hemodynamics; Immune stress·论 著·doi:10.3969/j.issn.1003-6350.2018.10.011
      基金项目:四川省泸州市科技局课题(编号:2015-s-26)

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