微创医学

目的观察预处理地塞米松对老年人腹腔镜手术应激反应及术后复苏的影响。方法采用抽签法对择期行腹腔镜结直肠肿瘤根治术的60例老年患者随机分成两组,每组30例,分为地塞米松预处理组(实验M组)和未用地塞米松预处理组(对照N组),ASAⅠ～Ⅱ级。两组分别在麻醉前30 min(T0)、气腹即刻(T1)、气腹后1 h(T2)、放气腹时(T3)、术毕后2 h(T4)以及术后1 d(T5)5个时点采静脉血3 mL,测定皮质醇浓度,并同时观察血流动力学的变化。对术中、术后复苏时不良事件的发生情况做对比,观察不良事件的发生情况。结果 M组在T1、T2、T3三个时点检测皮质醇浓度与N组比较差异有统计学意义,M组组内T1、T2、T3、T44个时点检测皮质醇浓度与T0比较差异有统计学意义,N组组内T1、T2、T33个时点检测皮质醇浓度与T0比较有统计学意义(P<0.05)。M组与N组在T1、T2、T3、T44个时点监测MAP比较(P<0.05)以及N组在T1、T2、T3、T44个时点监测MAP与T0比较差异有统计学意义。M组术后副反应及不良事件为寒战、恶心呕吐、呼吸困难、皮肤瘙痒,与N组比较M组明显好于N组(P<0.05),M组术中过敏发生情况与N组比较差异有统计学意义。结论地塞米松预处理能保持老年人对腹腔镜手术引起的保护性应激反应,可维持老年患者术中生命征稳定,以及减少术中术后复苏时副反应与不良事件的发生率,具有一定的临床意义。

Objective To observe the effect of dexamethasone pretreatment on surgical stress reaction and postoperative resuscitation in aged patients undergoing laparoscopic surgery． Methods Sixty aged patients of ASAⅠ －Ⅱ due to undergo laparoscopic radical resection for colorectal tumor were divided into two groups by lottery: the pretreatment group ( M group) and the control group ( N group) ， each group had 30 patients． The venous blood samples ( 3 ml) were taken at five time points of ante-induction( T0 ) ， loss of consciousness ( T1 ) ， intubation( T2 ) ，and at 1 min ( T3 ) ，3 min( T4 ) ，and 5 min( T5 ) after intubation，to determine the concentration of cortisol． Meanwhile the changes of hemodynamics at those time points in two groups were observed． Adverse events during operation and anesthesia recovery were also recorded．Ｒesults The concentrations of cortisol were of statistically significant difference at T1 ，T2 ，and T3 between two groups． In group M， the concentrations of cortisol were significantly changed at T1 ，T2 ，T3 ， and T4 compared with T0 ． In group N， the concentrations of cortisol also changed( P ＜ 0． 05) at T1 ，T2 ， and T3 compared with T0 ． The MAP were observed significantly different ( P ＜ 0． 05 ) at T1 ，T2 ，T3 ，and T4 between groups，and the MAP significantly changed at T1 ，T2 ，T3 and T4 compared with T0 in group N． The incidence rate of adverse events like chills，nausea and vomiting，dyspnea and pruritus was significantly lower( P ＜ 0． 05) in group M than in group N． The incidence rate of allergy was also much lower ( P ＜ 0． 05 ) in group M than in group N．Conclusion The administration of dexamethasone before laparoscopic surgery has the clinical significance of maintaining the protective stress reaction and the stability of hemodynamics，and lowering the incidence rate of adverse events during and after laparoscopic operation in aged patients．