不同手术方式下老年急性胆囊炎患者血清IL-2、IL-4、TNF-α、CRP动态水平及胃肠功能恢复时间的比较  

Comparisons of Dynamic Levels of Serum IL-2,IL-4,TNF-α,CRP and Gastrointestinal Function Recovery in Elderly Patients with Acute Cholecystitis Under Different Surgical Methods

作　　者：郭辉滢 王棣祥 

机构地区：[1]攀钢集团总医院密地院区急诊科,四川攀枝花617000

出　　处：《标记免疫分析与临床》2018年第1期94-98,共5页Labeled Immunoassays and Clinical Medicine

摘　　要：目的分析不同手术方式下老年急性胆囊炎患者血清炎症因子白介素-2(IL-2)、白介素-4(IL-4)、肿瘤坏死因子(TNF-α)、C反应蛋白(CRP)动态水平变化及胃肠功能恢复效果。方法回顾性选取我院2014年9月至2017年3月期间收治的98例老年急性胆囊炎患者的临床资料,根据手术方法不同分为LC组(腹腔镜胆囊切除术,n=50)和OC组(开腹胆囊切除术,n=48),两组麻醉、术后处理一致。分别于术前24h与术后3d、7d动态监测相关炎症因子水平,并评估术后胃肠功能恢复情况。结果两组术前各项炎症因子水平比较无统计学意义(P>0.05),术后3d、7d IL-4水平依次显著降低,而术后3d IL-2、TNF-α、CRP水平依次显著升高(P<0.05),均显著高于或低于正常范围;术后7d IL-2、TNF-α、CRP水平均明显回落(P<0.05),但OC组术后7d IL-2、TNF-α、CRP水平仍明显高于术前,仍略高于正常范围,而LC组则明显低于术前,基本恢复至正常范围内(P<0.05),且LC组术后3d、7d IL-4水平降低幅度明显小于OC组,术后3d IL-2、TNF-α、CRP水平升高幅度显著较OC组小,术后7d IL-2、TNF-α、CRP水平降低幅度显著较OC组大(P<0.05)。LC组术后肠鸣音恢复时间、肛门排气时间、排便时间及固体食物进食时间均显著较OC组短(P<0.05)。患者术后肠鸣音恢复时间、肛门排气时间、排便时间、固体食物进食时间与术后7d血清IL-2、TNF-α、CRP水平呈负相关,与IL-4水平呈正相关(P<0.05)。结论与传统开腹手术相比,LC治疗老年急性胆囊炎可一定程度降低机体因手术操作、疾病而产生的炎症反应,促进患者术后胃肠功能恢复。Objective To analyze the dynamic levels of serum inflammatory factors interleukin-2 （IL-2）, interleukin-4 （IL-4）, tumor necrosis factor （TNF-a）and C-reactive protein （CRP）and the effects of gastrointestinal function recovery in elderly patients with acute cholecystitis under different surgical methods. Methods The clinical data of 98 patients with acute cholecystitis admitted in our hospital from September 2014 to March 2017 were retrospectively selected and the patients were divided into the LC group（ n = 50） and the OC group （ open cholecystectomy, n = 48 ） according to the different surgical methods. And the two groups were given the consistent anesthesia, postoperative treatment. The levels of related inflammatory factors were monitored dynamically at 24h before operation and 3d and 7d after operation, and the postoperative recovery of gastrointestinal function was evaluated. Results The levels of inflammatory factors were not statistically different in the two groups before operation （ P 〉 0.05 ）, and the IL-4 level were significantly decreased successively at 3d,7d after operation. The levels of IL-2, TNF-α and CRP at 3d after operation were significantly increased（ P 〈 0.05 ）, which were significantly higher or lower than the normal range, and while the levels of IL-2 ,TNF-α and CRP at 7d after operation were significantly lower（ P 〈0.05 ）. But the levels of IL-2 ,TNF-ot and CRP at 7d after operation in the OC group were significantly higher than those of before operation, which were slightly higher than the normal range, and while the levels in the LC group were lower than those of before operation and they were recovered almost to the normal range （ P 〈 0.05 ）. The decreasing degree of the levels of IL-2 ,TNF-α and CRP in the LC group were significantly lower than those in the OC group at 3d and 7 days after operation,and the increasing degree of the levels of IL-2 and TNF-a and CRP were significantly lower than those in the OC group at 3d after operatio

关 键 词：老年 急性胆囊炎 LC 开腹胆囊切除术 炎症反应 胃肠功能 

分 类 号：R657.41[医药卫生—外科学]