NF-κB阻断剂对腹腔镜胆囊切除术后非切口疼痛及应激的防治研究  

Study on NF-KB Blocker for the Prevention and Treatment of Non-incision Pain and Stress after Laparoscopic Cholecystectomy

作　　者：陈前[1] 刘维燕[1] 江道文[1] 徐子平[1] 蒋渝[2] 

机构地区：[1]上海瑞金医院集团闵行区中心医院外科,上海201100 [2]上海瑞金医院外科,上海201000

出　　处：《医学临床研究》2011年第5期816-818,共3页Journal of Clinical Research

基　　金：上海市闵行区科委基金资助项目（2008MH032）

摘　　要：【目的】探讨核转录因子-kB（NF-kb）阻断剂乌司他丁对减轻腹膜损伤，减少机体应激反应，防治腹腔镜术后非切口疼痛的作用。【方法】通过选取腹腔镜胆囊切除手术病例，随机分为两组，每组20例；A组（腹腔镜手术）；B组（乌斯他丁＋腹腔镜手术）；术中切除腹膜组织，测定NF-xBmRNA表达量变化；术后6h抽取静脉血，检测IL-6，皮质醇（COR）；术后6h采用视觉模拟评分法（vAS），观察患者手术后非切口疼痛等症状。【结果】腹腔镜C0z气腹后，非切口疼痛发生部位以膈下及肩端疼痛、腹部胀痛等为主，A组发生率为75％，共计15例，VAS评分6．1；B组发生率为30％，共计6例，VAS评分3．1；A、B两组相比较差异有显著性（P〈O．05）。NF-KBmRNA在各组腹膜组织中均有不同程度的表达，术前两组无差异；术后两组均较术前增高（P〈O．05），A组更为明显；B组与A组术后相比，可明显降低NF-KBmRNA的量（P〈O．05）；术后6h，A、B两组血清I卜6的水平，明显高于术前（P〈0．05），术后B组血清IL_6的水平明显低于A组，且差异有显著性（P〈0．05）；两组手术6h后cOR均较术前上升，B组术后可降低c0R，与A组术后比较差异有显著性（P〈O。05）。【结论】c02气腹后非切口疼痛与NF-kB高表达相关，NP＊B阻断剂（乌司他丁）在一定程度上可阻断NF-kB高表达，减少应激，减少术后非切口疼痛发生率和程度。[Objective] To investigate the role of nuclear factor-xB（NF-kB） blocker ulinastatin（UTI） in alleviating peritoneal damage, decreasing the physical stress reaction, and preventing and treating non-incision pain after laparoscopic surgery. [Methods] The cases undergoing laparoscopic cholecystectomy were selected and randomly divided into 2 groups with 20 in each. Group A underwent laparoscopic surgery, and group B received UTI and laparoscopic surgery. The peritoneal tissue was intraoperatively excised to measure the change of NF-xB mRNA. The venous blood was drawn 6h after surgery to detect the IL-6 and cortiscosteroid（COR）. The visual analogue scale （VAS） method was used to observe the postoperative non-incision pain of patients 6h after surgery. [Results] After CO2 pneumoperitoneum laparoscopy, the non-incision pain was mainly the pain of diaphragm, shoulder and abdomen. The incidence of pain was 75 % （15 cases） and VAS score was 6.1 in group A, and the incidence of pain was 30%（6 cases） and VAS score was 3.1 in group B, and there was significant difference between two groups（ P d0.05）. NF-kB mRNA was expressed in peritoneal tissue in each group, but there was significant difference between two groups before surgery. Compared with before surgery, tho level of NF-kB mRNA in two groups increased after surgery（ P d0.05）, and that in group A increased more obviously. Compared with group A af- ter surgery, the surgery could obviously reduce the level of NF-kB mRNA in group B（ P d0.05）. The level of serum IL- 6 in group A and group B 6h after surgery was obviously higher than that before surgery（ P d0.05）. The level of serum IL-6 in group B after surgery was obviously lower than that in group A, and there was significant difference（ P d0.05）. Compared with before surgery, the level of COR in two groups 6h after surgery increased, and the surgery could reduce the level of COR in group B, and there was significant difference between two groups（ P d0.05）. [conclusion] Non-i

关 键 词：胆囊切除术 腹腔镜 NF-KB 疼痛 手术后 应激 

分 类 号：R657.4[医药卫生—外科学]