硬膜外麻醉胆囊切除术病人围术期血清胃动素及胃泌素变化

目的 研究硬膜外麻醉胆囊切除术病人围术期血清胃动素、胃泌素变化及其临床意义。方法 17例ASAⅠ、Ⅱ类择期胆囊切除术病人,分别于手术前(麻醉前)、麻醉后、胆囊摘除时、术后1d、2d和3d采集肘静脉血2ml,用放免方法测定MOT和GAS;观察记录术后肠鸣音和肛门排气时间。结果 本组病人术前血清MOT值(135.26±34.80)pmol/L,硬膜外麻醉后变化不显著(P>0.05);术中摘除胆囊时一过性升高,与术前相比,P<0.05,但术后1d和术后2d显著低于术前水平(P<0.05)。术后肠鸣音恢复时间平均为(27.82±10.64)h,肛门排气恢复时间平均为(68.62±32.74)h,与血清MOT水平呈显著负相关(r=-0.56,P<0.05)。血清GAS值变化无显著差异。结论 硬膜外麻醉本身对血清MOT、GAS均无明显影响,但仍不能完全抑制手术刺激引发的应激反应;后者可抑制MOT的分泌而影响术后胃肠运动功能的恢复。因此,进一步降低围术期手术应激反应和(或)术后给予外源性的MOT具有积极的意义,值得进一步研究。

Changes of perioperative serum motilin and gastrin in patients undergoing cholecystectomy under epidural anesthesia

Objective To examine the change(s )of perioperative serum motilin(MOT) and gastrin(GAS) in patients undergoing cholecystectomy under epidural anesthesia. Methods Seventeen ASA I and II patients after anesthesia,the time of removing gallbladder, and on 1st, 2nd and 3rd postoperative day for measuring serum MOT,GAS with radioimmunoassay. The peristaltic sound recovery timing(PSRT) and the anorectum exhaust timing(AET) were recorded. Results There was no significant change of MOT after anesthesia (126. 38±36.52) pmol/L in comparison with that of preanesthesia (135. 26±34. 80) pmol/L, but MOT increased transiently to (158. 14±43. 46 ) pmol/L, ( P < 0. 05 ) during removing gallbladder, and decreased to (121. 08±22.84) pmol/L and (122.43± 31.24) pmol/L on 1st and 2nd postoperative day compared with preanesthesia data(P<0.05). The PSRT and AET were (27. 82±10. 64) h and (68. 62±32. 74) h, respectively, which showed significantly negative relationship with serum MOT(r= - 0.56,P<0.05).No significant change was found in GAS. Conclusion Epidural anesthesia does not affect serum MOT and GAS level itself but it cannot completely inhibit the stress response resulted from surgery, which delays the recovery of postoperative gastrointestinal motility by inhibiting, the secretion of MOT. Therefore,it is suggested that further decrease of the stress response in perioperative surgery and /or administer exogenous MOT should be of important significance.