胸腔镜胸交感神经切断围术期机体炎性反应的临床观察  

Effect of thoracoscopic sympathectomy on the systemic inflammatory response

作　　者：孙来保[1] 蒋小朴[1] 谭敏[1] 刘松[1] 黄文起[1] 陈秉学[1] 

机构地区：[1]中山大学附属第一医院麻醉科,广州510080

出　　处：《广东医学》2005年第8期1059-1061,共3页Guangdong Medical Journal

基　　金：广东省医学科研基金资助项目(编号:A2002154)

摘　　要：目的探讨胸腔镜胸交感神经切断围术期机体炎性反应的临床效果。方法对20例择期手术和腋窝多汗症患者,在全凭静脉麻醉下行胸腔镜胸2-4交感神经切断术,麻醉采用双腔气管插管技术,术中为扩大手术视野,施行单双肺交替机械通气,应用放免法不同时机测定细胞炎性因子。结果全组患者顺利完成手术,麻醉效果满意;麻醉后血压和心率下降明显(P<0.01),术后2 h心率减慢(P<0.01);胸交感神经切断后患者手掌及腋窝明显干燥、变暖,掌心皮温显著升高(P<0.01);麻醉后机体炎性因子水平下降明显(P<0.05);手术结束时及术后2 h又显著升高(P<0.05及P<0.01)。结论胸腔镜胸交感神经切断术是治疗手及腋窝多汗症的有效方法, 双腔气管插管全凭静脉全麻安全可行,但手术结束后2 h内机体仍然存在应激及炎性反应,提示有必要预防用药。Objeetive To investigate the systemic inflammatory response of patients undergoing thoracoscopic sympathectomy. Methods 20 patients with palmar and axillary hyperhidrosis were treated. Second to fourth thoracic sympathetic ganglia were destroyed by electrocautery. The surgical procedures were performed under total intravenous anaesthesia, with one lungcollapsed ventilation through a double - lumen endotracheal tube. The serum cytokine concentration was determined by radioimmunogiceal method at different times, pre- anaesthesia, post-anaesthesia, immediately after and 2h after operation. Restilts All 20 patients had a satisfactory result. The MAP and HR after anaesthesia, also the HR 2 h after operation significantly decreased compared with the baseline value of pre - anaesthesia（ P 〈 0.01 ） ; The temperture of palmar skin significantly increased immediately after and 2h after operation（ P 〈 0.01 ）; The serum concentration of cytokines significantly decreased after anaesthesia, and subsequently increased significantly at the end of operation and at 2 h after operation（ P 〈 0.05 - 0.01 ）. Condusion Thoracoscopic sympathectomy is the most effective and minimally invasive treatment for palmar and axillary hyperhidrosis. The total intravenous anaesthesia using a double-lumen endotracheal tube is safe for the patients. Increased cytokines suggests that the systemic inflammatory response exists in patients at 2 h postoperative. We should use drugs to prevent complicafions.

关 键 词：胸腔镜 胸交感神经切断术 围术期 炎性反应 细胞因子 手术方法 

分 类 号：R651.4[医药卫生—外科学]