改良术中配合方案对大隐静脉曲张手术患者血流动力学、术后应激反应的影响  

Effect of modified intraoperative cooperation scheme on hemodynamics and postoperative stress response in patients with saphenous varicose vein surgery

作　　者：闫亚男 屈明[2] 孙光源 李铮 Yan Ya'nan;Qu Ming;Sun Guangyuan;Li Zheng(Operating Room,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China;Department of Vascular Glandular Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China;Department of Emergency Trauma Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei,China)

机构地区：[1]河北北方学院附属第一医院手术室,河北张家口075000 [2]河北北方学院附属第一医院血管腺体外科,河北张家口075000 [3]河北北方学院附属第一医院创伤急救外科,河北张家口075000

出　　处：《血管与腔内血管外科杂志》2022年第8期988-993,共6页Journal of Vascular and Endovascular Surgery

基　　金：张家口重点研发计划项目(20110017D)。

摘　　要：目的探讨改良术中配合方案对大隐静脉曲张(GSV)手术患者血流动力学、术后应激反应的影响。方法收集2020年1月至2022年1月河北北方学院附属第一医院接受手术治疗的98例GSV患者的临床资料,将2020年1—6月应用常规术中配合方案的49例患者纳入常规组,将2020年7月至2022年1月应用改良术中配合方案的49例患者纳入改良组。比较两组患者手术指标,包括手术时间、术中出血量;评估两组手术配合度;比较手术前后两组患者血流动力学指标,包括心率、平均动脉压;比较手术前后两组患者炎性反应指标,包括C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6);比较手术前后的凝血功能指标,包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)。统计两组患者术后不良反应发生情况。结果改良组患者手术时间、术中出血量均低于常规组患者,术中配合度评分高于常规组患者,差异均有统计学意义(P<0.05)。术毕即刻(T2),改良组患者心率、平均动脉压均低于常规组患者,差异均有统计学意义(P<0.05)。术后1 d,两组患者CRP、IL-6、TNF-α水平均高于本组术前,但改良组患者术后CRP、IL-6、TNF-α水平均低于常规组患者,差异均有统计学意义(P<0.05);两组患者PT、APTT、TT均短于本组术前,FIB、D-D水平均高于本组术前,但改良组患者术后PT、APTT、TT均长于常规组患者,FIB、D-D水平均低于常规组患者,差异均有统计学意义(P<0.05)。改良组患者术后不良反应总发生率低于常规组患者,差异有统计学意义(P<0.05)。结论改良术中配合方案可通过提高患者术中配合度实现缩短手术时间、减少术中出血的目标,降低患者术中血流动力学波动幅度,从而有效减轻患者术后应激反应程度,降低术后不良反应发生风险。Objective To investigate the effect of the modified intraoperative cooperation scheme on hemodynamics and postoperative stress response in patients with great saphenous varicose(GSV)surgery.Method The clinical data of 98 GSV patients who received surgical treatment from January 2020 to January 2022 in the First Affiliated Hospital of Hebei North University were collected.Among them,49 patients who received the conventional intraoperative cooperation program from January to June 2020 were included in the conventional group,and 49 patients who received the modified intraoperative assistance regimen from July 2020 to January 2022 were included in the modified group.The surgical indicators of operation time and intraoperative blood loss of the two groups were compared.The degree of cooperation between the two groups was evaluated.The hemodynamic indexes of heart rate and mean arterial pressure,were compared between the two groups before and after the surgery.The inflammatory response indexes of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)of the two groups before and after the surgery were compared.The coagulation function indexes of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),D-dimer(D-D)of the two groups before and after surgery were compared.The incidence of postoperative adverse reactions in the two groups of patients was counted.Result The operation time and intraoperative blood loss volume in the modified group were lower than those in the conventional group,the intraoperative cooperation score was higher than that in the conventional group,the differences were statistically significant(P<0.05).At immediately after operation(T2),the heart rate and mean arterial pressure of the modified group were lower than those of the conventional group,the differences were statistically significant(P<0.05).On the first day after the operation,the levels of CRP,IL-6,and TNF-αin the two groups were higher than those before the operation

关 键 词：大隐静脉曲张 腔内激光术 大隐静脉剥脱术 术中配合 血流动力学 术后应激反应 

分 类 号：R543[医药卫生—心血管疾病]