不同输液方案对择期腔镜下直肠肿瘤手术术中及术后早期IL-6、IL-10的影响

发布时间：2018-03-21 05:03

本文选题：肠道手术　切入点：围术期　出处：《昆明医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的观察比较术中限制性输液及开放性输液对择期腔镜下直肠肿瘤手术术中及术后IL-6(Interleukin-6, IL-6)、IL-10(Interleukin-10,IL-10)的影响,为选择较佳的输液方案提供依据。方法选取符合纳入标准的拟行肠道肿瘤切除术患者60例,随机分为限制输液组(Restrictive Fluid Group, RFG),开放输液组(Liberal Fluid Group,LFG),每组30例。RFG：入室开放静脉通路后以7ml/kg/h速度匀速输液至出手术室,LFG：以12ml/kg/h速度匀速输液至出手术室,两组晶胶比均为1：1。于麻醉诱导前(T0),手术结束时(T4),术毕4小时(T5),术后24小时(T6)分别抽取患者外周静脉血3m1,使用ELISA (Enzyme-Linked Immunosorbent Assay)法测血清中细胞因子IL-6、IL-10浓度。结果60名患者按排除标准予以排除,最终有41例入结果统计。其中RFG22例,LFG19例。两组患者基本情况及术中手术时间、气腹时间、机械通气时间、输液量、出血量、尿量、各时间点生命体征、血气结果及血管活性药物使用情况均无明显差异(P0.05)。围术期限制性输液组IL-6在手术结束时、术毕4小时及术后24小时均较开放性输液组低；围术期限制性输液组IL-10在手术结束时、术毕4小时及术后24小时均较开放性输液组高。差异均有统计学意义(P0.05)。结论与开放性输液相比,围术期采用限制性输液策略能够抑制促炎因子释放,促进抑炎因子释放,有利于降低术后早期的炎症反应。在胃肠手术过程中,适当地减少输液量,可能有利于患者术后早期的恢复。
[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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.37

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