不同剂量羟考酮对腹腔镜胆囊切除术患者血清血栓素A2、血浆内皮素水平和免疫功能的影响  

Effect of Different Doses of Oxycodone on Plasma Thromboxane A2,Plasma Endothelin Levels and Immune Function of Patients Underwent Laparoscopic Cholecystectomy

作　　者：吴丽[1] 薛娜[1] 吴献伟[1] 赵欣[1] 王志华[2] 

机构地区：[1]西安交通大学医学院附属红会医院麻醉科,陕西西安710054 [2]宁夏医科大学附属医院麻醉科,宁夏银川750004

出　　处：《现代生物医学进展》2017年第25期4864-4868,共5页Progress in Modern Biomedicine

基　　金：陕西省自然科学基金项目(20131037)

摘　　要：目的:探讨不同剂量羟考酮对腹腔镜胆囊切除术患者血清血栓素A2(TXA2)、血浆内皮素(ET)水平和免疫功能的影响。方法:选择2013年8月至2016年8月我院接诊的90例择期行腹腔镜胆囊切除术患者,以随机数表法分为3组,各30例。于手术开始前,均静脉注射羟考酮,A组剂量0.1 mg/kg、B组剂量0.2 mg/kg、C组剂量0.3 mg/kg。比较三组T0(入室后)、T1(麻醉诱导后)、T2(插管后)、T3(胆囊分离时)、T4(手术结束)时点血流动力学、TXA2、ET的变化以及T0、T5(术后2 h)、T6(术后1 d)、T7(术后3 d)时点免疫功能的变化;并记录拔管时间、苏醒时间、降压药、止痛药的使用情况及不良反应的发生情况。结果:三组在T2、T3时点舒张压(DBP)、收缩压(SBP)、心率(HR)较T0时点比较显著升高(P<0.05),B、C组在T2、T3时点DBP、SBP、HR均明显低于A组(P<0.05);三组T2、T3、T4时点TXA2较T0时点比较均显著升高,且A组>B组>C组,两两比较均具有显著差异(P<0.05);三组T2、T3时点ET较T0时点均显著升高(P<0.05),A组在T2、T3时点ET均明显高于B、C组(P<0.05);三组在T5时点CD3^+、CD4^+、CD8^+、CD4^+/CD8^+较T0时点比较均显著降低(P<0.05),A组在T5时点CD3^+、CD4^+、CD8^+、CD4^+/CD8^+均明显低于B、C组(P<0.05);C组拔管时间明显长于A、B组(P<0.05);C组不良反应总发生率明显高于A、B组(P<0.05)。结论:在胆囊切除术中,应用0.2 mg/kg羟考酮对血流动力学、TXA2、ET及免疫功能的影响较小,且安全性高。Objective：To study the effect of different doses of oxycodone on the serum thromboxane A2 （TXA2）,plasma endothelin （ET） levels and immune function of patients underwent laparoscopic cholecystectomy.Methods：90 patients of elective laparoscopic cholecystectomy who were treated from August 2013 to August 2016 in our hospital were selected and divided into 3 groups by random number table,with 30 cases in each group.At the beginning of operation,they were given intravenous oxycodone,group A was given 0.1 mg/kg oxycodone,group B was given 0.2 mg/kg oxycodone,group C was given 0.3 mg/kg oxycodone.The changes of hemodynamics,serum TXA2 and ET levels were compared between the three groups at T0 （after admission）,T1 （after anesthesia induction）,T2 （after intubation）,T3 （gallbladder separation）,T4 （end of surgery） and the changes of immune function was compared at T0,T5 （postoperative 2h）,T6（postoperative 1d）,T7 （postoperative 3d）;and the extubation time,recovery time,hypotensor,additional analgesics situationin and adverse reactions were recorded.Results：The diastolic pressure （DBP）,systolic blood pressure （SBP）,heart rate （HR） in three groups at T2,T3 point was significantly higher than T0 point（P〈0.05）,the DBP,SBP and HR in the B,C groups were significantly lower than the A group at T2 and T3 point（P〈0.05）;the TXA2 in three groups at T2,T3,T4 point was significantly higher than T0 point（P〈0.05）,and A group〉B group〉C group,there was significant difference between the two groups （P〈0.05）;the ET in three groups at T2,T3 point was significantly higher than T0 point（P〈0.05）,the ET in the B,C group was significantly higher than the A group at T2,T3 point（P〈 0.05）;the CD3＋,CD4＋,CD8＋ and CD4＋/CD8＋ of the three groups at T5 point were significantly lower than that ofT0 point （P〈0.05）,the CD3＋,CD4＋,CD8＋ and CD4＋/CD8＋ in A group were significantly lower than that of B,C group at T5 point （P〈0.05）;the ext

关 键 词：腹腔镜胆囊切除术 羟考酮 血栓素A2 血浆内皮素 免疫功能 THROMBOXANE A2 

分 类 号：R657.4[医药卫生—外科学]