腹腔镜胆囊切除术患者围术期多项血清应激状态相关指标变化观察

目的:分析腹腔镜胆囊切除术的临床疗效,分析其对血清应激指标的影响。方法:将160例来我院行胆囊切除术的患者随机分为两组,对照组和观察组各80例。对照组采用开腹胆囊切除术,观察组则采用腹腔镜胆囊切除术。比较两组间手术时间、术中出血量、肠功能恢复时间以及住院天数差异,比较治疗前后两组患者间血清应激相关指标皮质醇(COR)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)、多巴胺(DA)以及胰岛素(INS)、三碘甲状腺原氨酸(T3)、甲状腺素(T4)、促甲状腺激素释放激素(TSH)水平差异。结果:观察组患者手术时间、术中出血量、肠功能恢复时间以及住院天数均显著少于对照组(P<0.05)。血清COR、NE、ACTH、DA和INS、T3水平在围手术期均发生了显著变化,各项指标均在胆囊分离时就明显升高,术后24 h开始下降(P<0.05);术后观察组上述指标均显著低于对照组(P<0.05)。结论:腹腔镜胆囊切除术对机体应激反应影响小于开腹手术,更利于患者术后康复。

The observation of several serum stress related indicators changes of lapa-roscopic cholecystectomy patients in perioperative

Objective:To analyze the clinical efficacy of laparoscopic cholecystectomy and its effect on serum stress related in-dicators. Methods:160 cases of patients who took cholecystectomy in our hospital were randomly divided into control group and observa-tion group,80 cases in each group. The control group was taken open cholecystectomy,and the observation group was taken laparoscopic cholecystectomy. The differences of operative time,blood loss,intestinal function recovery time and hospital stay of two groups were com-pared,and the serum stress related indicators such as cortisol,norepinephrine,adrenocorticotropic hormone,dopamine and insulin,three triiodothyronine,thyroxine,thyroid-stimulating hormone-releasing hormone of two groups before and after the cholecystectomy were com-pared. Results:The operative time,blood loss,intestinal function recovery time and hospital stay of observation group were significantly smaller than the control group. The serum levels of COR,NE,ACTH,DA and INS,T3 were undergone significant changes in the periop-erative period,these indicators were significantly increased in the gallbladder separation,began to decline after 24 h(P<0. 05);these indicators of observation group were significantly lower than that of control group postoperative,all P<0. 05. Conclusion:Compared to open cholecystectomy,laparoscopic cholecystectomy has a small influence on stress response,and will be conducive to the rehabilitation of patients after cholecystectomy.