罗哌卡因腰麻对腹膜透析置管术患者炎症因子的影响  

Spinal anesthesia with ropivacaine effect the inflammatory factors in patient with peritoneal dialysis catheter placement

作　　者：张蔚青[1] 杨榕[1] 阙彬[1] 倪卫国[1] 徐珂[1] 刘胜强[1] 梁志鹏[1] 

机构地区：[1]杭州市中医院麻醉科

出　　处：《中国临床药理学与治疗学》2013年第4期404-407,共4页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：浙江省医药卫生科技计划项目(2010KYA169);浙江省医学会临床科研资金(2010ZYC-A22)

摘　　要：目的:对比腰麻和局部麻醉下行腹膜透析置管术患者围手术期白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hs-CRP)、血糖(BS)的变化。方法:将实施腹膜透析置管术的终末期肾病患者40例按病因配对分为腰麻组(SA组)和局部麻醉组(LA组),SA组和LA组患者分别在腰麻和局部麻醉下行腹膜透析置管术,分别于术前、术毕和术后6h采血测IL-6、TNF-α、hs-CRP、BS,记录患者切皮时、进腹后和术毕时的视觉模拟评分(VAS)及手术时间。结果:两组患者术前、术毕血清IL-6、TNF-α、hs-CRP差异无统计学意义(P>0.05)。与术前比较,LA组术后6h血清IL-6、TNF-α、hs-CRP升高(P<0.05)。与LA组比较,SA组术后6h血清IL-6、TNF-α、hs-CRP降低(P<0.05)。两组患者术前、术毕、术后6hBS值差异无统计学意义(P>0.05)。与LA组患者比较,SA组患者手术切皮时、进腹后、手术结束时VAS评分低,手术时间短(P<0.01)。结论:与局部麻醉比较,腰麻下行腹膜透析置管术可明显减轻患者围术期疼痛,缩短手术时间,减少IL-6、TNF-α、hs-CRP的产生。AIM： To compare the level of perioperative serum Interleukin-6 （IL-6）, tumor necrosis factor-α （TNF-α）, high sensitive c-reac- tive protein （hs-CRP） and blood sugar （BS） be- tween the patients with spinal anesthesia and lo- cal anesthesia in peritoneal dialysis catheter placement. METHODS： Forty patients with end stage kidney disease scheduled for peritoneal di- alysis catheter placement allocated to one of two groups （n= 20 each）： group SA received spinal anesthesia, group LA received local anesthesia. The serum IL-6, TNF-α, hs-CRP, BS were measured before operation, at the end of opera- tion and 6 hours after operation, both the visual analogue scale（VAS） while skin incision, open abdominal and at the end of operation and the operation time were recorded. RESULTS. IL-6, TNF-α, hs-CRP were no significant difference between two groups before operation and at theend of operation （P 〉 0.05）. Compared with group LA, IL-6, TNF-α, hs-CRP in group SA 6 hours after operation were significantly lower （P 〈0.05）. Compared with before operation, IL- 6, TNF-α, hs-CRP in group SA 6 hours after operation were significantly lower （P〈0.05）. BS at any time were no significant difference be- tween two groups （P〉0.05）. Compared with group LA,VAS was significantly lower in group SA at any time, operation time was significantly shorter （P 〈 0. 01）. CONCLUSION. Compared with local anesthesia, peritoneal dialysis catheter placement under spinal anesthesia has advanta： ges of lighter pain, shorter operation time and less inflammatory factor.

关 键 词：腹膜透析 置管术 麻醉 脊髓 炎症 

分 类 号：R614[医药卫生—麻醉学]