老年病人腹部大手术后应激反应研究  

Study of surgical stress on the aged abdominal major operation patients

作　　者：张娟娟[1] 高涛[1] 习丰产[1] 虞文魁[1] 朱维铭[1] 李宁[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002

出　　处：《中国实用外科杂志》2014年第2期161-163,共3页Chinese Journal of Practical Surgery

摘　　要：目的观察老年病人和非老年病人腹部大手术后应激反应的区别。方法选择2013年2-4月南京军区南京总医院普外科需行胃肠道肿瘤手术病人73例,分为老年组(36例)和非老年组(37例),监测两组术前及术后第1、2、3天的生命体征、白细胞计数(WBC)、中性粒细胞比例(N)、C-反应蛋白(CRP)、血浆皮质醇(P-C)、促肾上腺素皮质激素(ACTH),并进行统计分析。结果老年组术后第1天P-C明显高于非老年组(P=0.049);老年组术后第1、2天CRP明显低于非老年组(P=0.046和0.008);两组术后各时间点WBC、N、ACTH差异无统计学意义(P>0.05)。结论行腹部大手术的老年病人术后应激激素血浆皮质醇的分泌较非老年病人明显增高,但其炎性反应却无明显增高甚至低于非老年病人。Objective To investigate the difference of surgical stress on the aged and non-aged abdominal major operation patients. Methods From February to April in 2013, a prospective study was performed of abdominal operation patients with gastrointestinal neoplasms in research institude of general surgery, including 36 aged patients （≥65 years old） and 37 non-aged patients （ 〈 65 years old）. We observed differences of postoperative vital sign, white blood cell count, neutrophil proportion, C-reactive protein, plasma cortisol and ACTH in two groups, and analyzed these dates. Results Compared with the non-aged group, plasma cortisol of the first day after operation in aged group was much higher, P=0.049. C-reactive protein of the first day and the second day after operation in aged group was much lower, P（D1）=0.046, PIp21=0.008. There were no differences of white blood cell count, neutrophil proportion and ACTH in two groups. Conclusion Compared with the non-aged patients, the stress hormone plasma cortisol of the aged abdominal major operation patients was much higher after operation, but the inflammatory reaction was not higher, and even lower.

关 键 词：老年人 腹部大手术 血浆皮质醇(P—C) 促肾上腺素皮质激素(ACTH) C反应蛋白(CRP) 应激反应 

分 类 号：R6[医药卫生—外科学]