【摘要】 目的　比较手术方式和术后镇痛对胆囊切除术患者血浆内毒素、C反应蛋白 (CRP)及细胞因子含量的影响。方法　 36例ASAⅠ～Ⅱ级行择期胆囊切除患者 ,按手术方式及是否术后镇痛分为腹腔镜非镇痛组 (Ⅰ组 )、经腹手术非镇痛组 (Ⅱ组 )、经腹手术吗啡镇痛组 (Ⅲ组 )。麻醉方法均为全凭静脉麻醉。Ⅱ、Ⅲ组于诱导前、拔管前、术后 2 4h、术后 72h、术后 5d五个时间点 ,Ⅰ组仅取前四个时点 ,分别抽取静脉血测血浆内毒素、CRP、白细胞介素 2 (IL 2 )、白细胞介素 6 (IL 6 )、白细胞介素 1 0 (IL 1 0 )及游离白细胞介素 2受体 (sIL 2R)含量。结果　各组术后血浆内毒素、CRP、IL 6、IL 1 0、sIL 2R含量均升高 ,而IL 2含量则降低 ,术后 2 4h达峰值 ,此后逐渐恢复。组间比较 ,Ⅱ、Ⅲ组各项指标变化幅度均大于Ⅰ组 (P <0 0 5 ) ,血浆内毒素、IL 2变化程度相似 (P >0 0 5 ) ;但Ⅲ组CRP、IL 6变化程度小于Ⅱ组 ,IL 1 0、sIL 2R则大于Ⅱ组 (P <0 0 5 )。结论　腹腔镜胆囊切除术较经腹胆囊切除术创伤小、应激反应轻、对机体免疫系统干扰小 ;经腹组术后采用吗啡静脉镇痛可减轻术后炎症和应激反应更多还原

【Abstract】 Objective To investigate the changes of plasma concentrations of C reactive protein(CRP) and cytokines in patients undergoing different surgical methods with or without morphine patient controlled analgesia(PCA).Methods 36 patients (ASAⅠ Ⅱ) undergoing cholecystectomy were divided into three groups.Laparoscopic cholecystectomy without PCA was performed in group Ⅰ,abdominal cholecystectomy without PCA in groupⅡ,and with morphine PCA in groupⅢ.Total intravenous anesthesia was administered.Plasma levels of endotoxin,CRP,sIL 2R,IL 2,IL 6 and IL 10 were measured before anesthesia and extubaion,at 24 h,72 h after operation in group Ⅰ,and on the 5th day additionally in group Ⅱand Ⅲ.Results The plasma levels of endotoxin,CRP,IL 2, IL 6, IL 10 and sIL 2R were significantly increased,and IL 2 decreased before extubation,at 24 h,72 h after operation compared with those before induction in all three groups.The changes reached to the peak at 24 h after surgery,and then recovered gradually.Comparing with the level before surgery,all parameters were changed more evidently in group Ⅱ and Ⅲ than those in group Ⅰ( P< 0 05).The changes of endotoxin and IL 2 were similar in group Ⅱ and Ⅲ( P> 0 05).The changes of CRP and IL 6 were less,but IL 10 and sIL 2R were greater in group Ⅲ than those in groupⅡ( P< 0 05). Conclusions Trauma,stress and disturbance in immune state are less in laparoscopic cholecystectomy than those in abdominal cholecystectomy. PCA with morphine can inhibit inflammatory response after abdominal surgery.更多还原