發(fā)布時(shí)間：2018-03-21 05:03

  本文選題：腸道手術(shù)　切入點(diǎn)：圍術(shù)期　出處：《昆明醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的觀察比較術(shù)中限制性輸液及開放性輸液對(duì)擇期腔鏡下直腸腫瘤手術(shù)術(shù)中及術(shù)后IL-6(Interleukin-6, IL-6)、IL-10(Interleukin-10,IL-10)的影響,為選擇較佳的輸液方案提供依據(jù)。 方法選取符合納入標(biāo)準(zhǔn)的擬行腸道腫瘤切除術(shù)患者60例,隨機(jī)分為限制輸液組(Restrictive Fluid Group, RFG),開放輸液組(Liberal Fluid Group,LFG),每組30例。RFG：入室開放靜脈通路后以7ml/kg/h速度勻速輸液至出手術(shù)室,LFG：以12ml/kg/h速度勻速輸液至出手術(shù)室,兩組晶膠比均為1：1。于麻醉誘導(dǎo)前(T0),手術(shù)結(jié)束時(shí)(T4),術(shù)畢4小時(shí)(T5),術(shù)后24小時(shí)(T6)分別抽取患者外周靜脈血3m1,使用ELISA (Enzyme-Linked Immunosorbent Assay)法測(cè)血清中細(xì)胞因子IL-6、IL-10濃度。 結(jié)果60名患者按排除標(biāo)準(zhǔn)予以排除,最終有41例入結(jié)果統(tǒng)計(jì)。其中RFG22例,LFG19例。兩組患者基本情況及術(shù)中手術(shù)時(shí)間、氣腹時(shí)間、機(jī)械通氣時(shí)間、輸液量、出血量、尿量、各時(shí)間點(diǎn)生命體征、血?dú)饨Y(jié)果及血管活性藥物使用情況均無明顯差異(P0.05)。圍術(shù)期限制性輸液組IL-6在手術(shù)結(jié)束時(shí)、術(shù)畢4小時(shí)及術(shù)后24小時(shí)均較開放性輸液組低；圍術(shù)期限制性輸液組IL-10在手術(shù)結(jié)束時(shí)、術(shù)畢4小時(shí)及術(shù)后24小時(shí)均較開放性輸液組高。差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論與開放性輸液相比,圍術(shù)期采用限制性輸液策略能夠抑制促炎因子釋放,促進(jìn)抑炎因子釋放,有利于降低術(shù)后早期的炎癥反應(yīng)。在胃腸手術(shù)過程中,適當(dāng)?shù)販p少輸液量,可能有利于患者術(shù)后早期的恢復(fù)。
[Abstract]:Objective to observe and compare the effects of intraoperative restrictive infusion and open infusion on interleukin 6 (IL 6) and interleukin 10 (IL 10) during and after selective endoscopic rectal tumor surgery in order to provide evidence for the selection of better infusion regimen. Methods 60 patients with intestinal neoplasms who met the inclusion criteria were selected. They were randomly divided into two groups: restricted Fluid group (RFGG) and open infusion group (Fluid group). 30 patients in each group were treated by opening venous access. RFG was given at a rate of 7 ml / kg / h to an operating room with a uniform velocity of 12 ml / kg / h to the operating room, and then to the operating room at a speed of 12 ml / kg / h at a uniform velocity of 12 ml / kg / h. The ratio of crystal to glue in both groups was 1: 1. Before anesthesia induction, T _ (0), T _ (4) and T _ (5) at the end of operation, and 24 hours after operation, the peripheral venous blood samples were taken from the patients. The concentration of IL-6IL-10 in serum was measured by ELISA Enzyme-Linked Immunosorbent assay. Results Sixty patients were excluded according to the exclusion criteria, and 41 cases were included in the final results. Among them, 19 cases were RFG22. The basic condition and operative time, pneumoperitoneum time, mechanical ventilation time, transfusion volume, blood loss and urine volume were observed in the two groups. There was no significant difference in vital signs, blood gas results and the use of vasoactive drugs at different time points (P 0.05). At the end of the operation, IL-6 in the restricted infusion group was lower than that in the open infusion group at the end of operation at the end of operation and 24 hours after operation. At the end of operation, IL-10 in the perioperative restricted infusion group was significantly higher than that in the open infusion group at 4 hours after operation and 24 hours after operation, and the difference was statistically significant (P 0.05). Conclusion compared with open infusion, restrictive infusion strategy in perioperative period can inhibit the release of proinflammatory factor, promote the release of anti-inflammatory factor, and reduce the early inflammatory reaction after operation. It may be beneficial to early recovery after operation.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.37

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 吳恒義;顧葆春;;限制性液體復(fù)蘇臨床應(yīng)用中幾個(gè)應(yīng)注意的問題[J];創(chuàng)傷外科雜志;2006年01期

2 徐楓;楊承祥;仲吉英;張濤;;術(shù)前靜脈注射帕瑞昔布鈉對(duì)膝關(guān)節(jié)置換術(shù)患者IL-6、IL-10、TNF-α和VCAM-1的影響[J];廣東醫(yī)學(xué);2011年06期

3 楊廣林,龔圣濟(jì),王和賢,郭竹英;早期復(fù)蘇中高滲鹽膠體對(duì)小腸黏膜形態(tài)學(xué)的影響[J];中華急診醫(yī)學(xué)雜志;2005年11期

4 張春龍;劉建偉;;限制性輸液在腹部外科的應(yīng)用進(jìn)展[J];中華普通外科學(xué)文獻(xiàn)(電子版);2009年05期

5 王曉鋒;劉海瑞;;全髖關(guān)節(jié)置換手術(shù)患者麻醉維持期限制性輸液復(fù)蘇與高容量血液稀釋應(yīng)用比較[J];江蘇大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2012年02期

，

本文編號(hào)：1642371