大鼠肝部分切除术后腹腔神经丛阻滞抑制早期应激反应  

Postoperative early stress response alleviated by celiac plexus block after partial hepatectomy in rats

作　　者：魏晓红[1] 林露[1] 李军[2] 牛洁[2] 刘小燕[1] 

机构地区：[1]成都军区总医院心血管外科,四川成都610083 [2]成都军区总医院麻醉科,四川成都610083

出　　处：《局解手术学杂志》2017年第2期79-82,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：成都军区医学科学技术研究计划重点项目(B14010);成都军区总医院院管课题(2013YG-B010)

摘　　要：目的观察大鼠肝部分切除术(PH)后给予腹腔神经丛阻滞(NCPB)对早期应激反应的影响。方法 30只健康清洁雄性SD大鼠,随机分为对照组和NCPB组,每组15只,均构建大鼠70%PH模型。NCPB组在PH术毕关腹前给予0.5%利多卡因的NCPB,而对照组以0.9%生理盐水替换。分别于术后6 h、12 h、24 h测定血清C反应蛋白(CRP)、皮质酮(GC)、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NA)、肾上腺素(AD)浓度及肿瘤坏死因子(TNF)-α、白介素(IL)-1β水平,并通过Western blot分析外周血单核细胞(PBMCs)糖皮质激素受体(GR)的蛋白表达。结果 PH术后24 h内大鼠产生明显的应激反应,术后血清CRP、GC、ACTH、NA及AD浓度均有不同程度的升高,但在相应时间点NCPB组均显著低于对照组(P<0.01或P<0.05);对照组PBMCs的GR蛋白表达在PH术后明显下降,在相应时间点NCPB组均显著高于对照组(P<0.01);无论是对照组还是NCPB组的血清TNF-α和IL-1β水平在术后24 h内均逐渐升高,但在相应时间点NCPB组均显著低于对照组(P<0.01或P<0.05)。结论 PH术中给予NCPB可有效抑制术后早期应激反应,有助于减轻全身性炎症反应。Objective To investigate the effects of neurolytic celiac plexus block （NCPB） on stress response during the early stage of partial hepatectomy（PH） postoperation in rats. Methods Thirty healthy SPF-grade male Sprague-Dawley rats were randomly divided into control group and NCPB group,and then were constructed the 70% PH model. NCPB group received NCPB with 0.5% lidocaine before clos- ing abdominal, and control group received the same procedures, but 0.9% physiological saline was injected instead of 0.5 % lidocaine. The serum concentration of CRP,GC,ACTH,NA and AD,and the levels of serum TNF-α and IL-1β were determined at 6 hours, 12 hours and 24 hours after PH. The western blot assay was performed to examine the expression of GR in the peripheral blood mononuclear cells （ PB- MCs）. Results The obvious stress response was produced within 24 hours after PH in rats, postoperative serum CRP, GC, ACTH, NA and AD concentrations increased in the different extent, but the NCPB group were significantly lower than those in the control group in the corre- sponding time point （ P 〈 0.01 or P 〈 0.05）. The expression levels of GR in PBMCs in the control group were significantly decreased after PH, and markedly lower than those in the NCPB group in the corresponding time point （P 〈 0.01 ）. The serum TNF-α and IL-1β levels were gradually increased in the control group and NCPB group within 24 hours after PH. But at the respective time points, the levels in the NCPB group were significantly lower than those in control group （P 〈 0.01 or P 〈 0.05 ）. Conclusion Intraoperation NCPB can effectively inhibit postoperative stress response at the early stage after PH, and thereby help to reduce the degree of systemic inflammatory response.

关 键 词：肝部分切除术 腹腔神经丛阻滞 应激反应 

分 类 号：R614.4[医药卫生—麻醉学]