盐酸氢吗啡酮用于老年腹腔镜胆囊切除术效果观察  

Observation of Hydromorphone Hydrochloride on Laparoscopic Cholecystectomy in Elder Patients

作　　者：井玉生[1] JING Yusheng(Department of Anesthesiology, Second People＇ s Hospital of Liaocheng, Liaocheng 252600, Shangdong, China)

机构地区：[1]聊城市第二人民医院麻醉科,山东聊城252600

出　　处：《贵州医科大学学报》2017年第7期855-858,共4页Journal of Guizhou Medical University

摘　　要：目的:观察盐酸氢吗啡酮对腹腔镜胆囊切除术老年患者气管插管时刻的应激反应及围术期细胞因子的影响。方法:选择行腹腔镜胆囊切除术的老年患者80例,随机均分为观察组和对照组;两组均与相同的静脉给药麻醉前诱导,静脉注射完毕后观察组静注盐酸氢吗啡酮15μg/kg,对照组给予等量生理盐水;比较两组麻醉诱导前、插管前30 s、插管即刻及插管后5 min时的平均动脉压(MAP)和心率(HR),并均于诱导前、切皮时、切皮30 min及手术结束时检测血清白细胞介素-1(IL-1)、白细胞介素-8(IL-8)及肿瘤坏死因子(TNF-α)水平,同时观察两组患者围术期不良反应。结果:观察组MAP及HR在插管即刻及插管后5 min均低于对照组,差异有统计学意义(P<0.05);同组内比较,观察组MAP及HR在插管前30 s时低于诱导前(P<0.05),对照组MAP及HR水平在插管即刻及插管后5 min均高于诱导前(P<0.05);两组患者切皮时、切皮30 min及手术结束时IL-1、IL-8及TNF-α水平均有所升高,但观察组切皮时、切皮30 min及手术结束时IL-8及TNF-α水平低于对照组,且切皮30 min及手术结束时IL-1低于对照组(P<0.05);两组围术期不良反应发生率比较差异无统计学意义(χ~2=0.213,P>0.05)。结论:盐酸氢吗啡酮可降低腹腔镜胆囊切除术老年患者气管插管应激反应,血流动力学更为平稳,且可降低围术期细胞因子水平。Objective： To observe the effect of hydromorphone hydrochloride on laparoscopic chole cystectomy in elderly patients with tracheal intubation stress response and perioperative cytokine. Methods： 80 elderly patients underwent laparoscopic eholecystectomy were randomly divided into two groups with 40 cases each as observation group and control group. Two groups were given same induction before intravenous injection anesthesia; then the observation group was given intravenous hydro- morphone hydrochloride 15μg/kg; the control group received same volume normal saline. Average MAP and HR were compared at different times： before induction, 30s before intubation, the moment of intubation, 5min after intubation, and 30s after anesthesia induction; testing serum interleukin-1 （IL- l ）, interleukin-8 （IL-8） and tumor necrosis factor （TNF-α） level at the time of before induction, skin incision, 30min after skin incision and the operation was completed, and observing adverse reac- tion of patients of both groups during perioperative period. Results： Immediately after intubation and 5 min after intubation, MAP and HR of observation group were lower than that of control group （P 〈0. 05） ; compared with the same group, 30s before intubation, MAP and HR of observation group were lower than before induction（ P 〈 0.05 ）, MAP and HR of control group at the moment of intubation and 5rain after intubation were higher than before ind^action （P 〈0. 05 ）. During skin incision, level of IL- l, IL-8 and TNF-αl of both groups at 30rain after skin incision and end of operation were increased ; while these levels of observation group were lower than that of control group at the same point of time, and IL-1 of observation at 30min after skin incision and end of operation were lower than control group （P 〈 0. 05 ） ; comparison of adverse reaction occurrence rate during perioperative period of the two groups had no significant difference （χ2 =0. 213,P 〉0.05）. Conclusion： Hydromorphone hydr

关 键 词：胆囊切除术 腹腔镜 插管法 气管 老年人 盐酸氢吗啡酮 

分 类 号：R575.6[医药卫生—消化系统]