35例肿瘤开胸患者围手术期血清Cortisol、血浆Ang-Ⅱ及相关因素分析  

Perioperative Changes of Serum Cortisol and Plasma Angiotensin Ⅱ Levels in Patients Undergoing Thoracotomy for Malignancy

作　　者：田润华[1] 李雨升[2] 余云云[2] 李馨[3] 郑春喜[4] 伦立民[1] 

机构地区：[1]青岛大学医学院附属医院检验科,266003 [2]青岛大学医学院附属医院放免中心,266003 [3]青岛大学医学院生物化学教研室,266003 [4]青岛大学医学院商业医院检验科,266003

出　　处：《放射免疫学杂志》2006年第6期453-455,共3页Journal of Radioimmanology

摘　　要：目的：分析探讨具有手术指征的35例肿瘤患者开胸手术期间应激状态的变化。方法：经临床证实无严重高血压、心脏病、垂体瘤及相关影响体内皮质醇（Cortisol）、血管紧张素Ⅱ（Ang～Ⅱ）水平疾病且具有手术指征的35例肿瘤开胸患者，应用放射免疫分析分别测定术前、术中1h、术毕及术后1d血清Cortisol及Ang-Ⅱ的含量，手术期间同时测定舒张压、收缩压及心率。结果：肿瘤开胸患者手术期间血清Cortisol及血浆Ang～Ⅱ存在差异（F=3．184—10．824，P〈0．001—0．05）。麻醉手术期间，Cortisol与心率进行性升高两者有较好的对应性，术毕时达高峰。年龄分组（老年组A组≥60岁），对照组B组〈60岁，除术前收缩压A组明显高于B组外（t=2．099，P〈0．05）其它各期指标无显著性差异（t=-1．887～1．481，P〉0．05）。控制年龄与性别后的相关分析表明，术中1h心率与术中1h Ang-Ⅱ呈正相关（r=0，631，P〈0．01）；术毕心率与术毕Cortisol、术毕Ang-Ⅱ呈正相关（r=0．511，P〈0．01；r=0．472，P〈0．05），术毕心率与术毕Cortisol、术毕Ang—Ⅱ的逐步回归分析表明只有术毕Cortisol进入回归方程。Cortisol与Ang-Ⅱ的各期无昆著相关性。结论：手术期问血清Cortisol及血浆Ang-Ⅱ水平明显升高，血清Cortisol在手术应激过程中是一较敏感指标；老年人对手术成激过程反应良好；心率及应激指标水平的升高可能互为因果；开胸手术期间应密切监测开胸患者血清Cortisol及血浆Ang-Ⅱ的水平．作好相应的护理．特别是老年人．以避免或减少其它并发症的发生几率。Objective To investigate the perioperative changes of serum stress hormones cortisol and plasma angiotensin Ⅱ in patients undergoing thoracotomy for malignancy. Methods Serum cortisol and plasma angiotensin Ⅱ levels were measured with RIA repeatedly in 35 thoracotomy patients operated for malignancy before operation, 1h after starting operation, at the end of operation, and one day later, Heart rate and blood pressure were constantly monitored during operation. Results The serum levels of cortisol and plasma angiotensin- Ⅱ rose gradually during operation with significant differences among the measurements （P 〈0. 001 -0.05） , No age -difference for the measurements was observed except for a h;gher systolic pressure in patients over 60. Heart rates at 1h were positively correlated with 1 h angiotensin - Ⅱ levels. Heart rates at the end of operation were positively correlated with the tort]sol and angiotensin- Ⅱ levels at that time. Conclusion The serum levels of these stress hormones rose significantly during the operation. Stress reponses in older patients were adequate, yet the higher levels of stress hormones might bring more adverce effect in elderly people, especially cognition impairement. Smooth anaesthesia and adequate post - operative analgesia would lessen the stress effect,providing more ideal recovery, especially for the older patients.

关 键 词：肿瘤 开胸手术 皮质醇 血管紧张素Ⅱ 血压 心率 

分 类 号：R73[医药卫生—肿瘤]