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内皮素和降钙素基因相关肽(calcitonin gene-ralated peptide, CGRP)是一对调节血管收缩与舒张功能的重要物质[1],其合成、分泌及效应失衡可致血管紧张度改变,并直接影响血流动力学的稳定性,是围手术期创伤与应激时病理生理改变的重要原因。为有效观察中老年患者围手术期血浆内皮素、CGRP水平的变化,我们收集了60例中老年行胆囊切除术的患者,并分别按时相及年龄进行内皮素和CGRP水平的观测。
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对照组与实验组患者围手术期血浆内皮素和CGRP水平变化见表 1、表 2。
时期 T0期 T1期 T2期 T3期 T4期 对照组(< 65岁) 83.63±11.87 85.60±12.43 87.93±14.76 84.48±12.43 85.09±17.19 实验组(> 65岁) 87.15±15.91 100.46±14.52 114.23±23.86 110.73±17.78 95.11±22.89 t值 0.971 4.258 5.134 6.627 1.917 P值 0.583 0.024 0.008 0.001 0.283 表 1 对照组与实验组胆束疾病患者围手术期血浆内皮素水平
(x±s,pg/ml) 时期 T0期 T1期 T2期 T3期 T4期 对照组(< 65岁) 80.63±12.07 90.38±11.06 88.15±17.22 88.96±18.14 89.50±9.13 实验组(> 65岁) 83.85±14.44 75.48±16.64 86.17±16.39 110.23±22.01 87.54±20.68 t值 0.937 4.084 0.456 4.085 0.475 P值 0.595 0.030 0.796 0.030 0.787 表 2 对照组与实验组胆束疾病患者围手术期血浆降钙素基因相关肽水平
(x±s,pg/ml) 从表 1可以看出:实验组患者T1期内皮素水平开始上升,并在T2期达到高峰,T4期又恢复至T0期水平;而对照组患者内皮素水平升高不明显。再从时相分组来看,实验组患者T0期血浆内皮素水平均高于对照组,但两组之间比较差异无统计学意义(t=0.971,P > 0.05);T1期两组患者血浆内皮素水平均有升高,而且实验组显著高于对照组(t=4.258,P < 0.05);T2期两组患者血浆内皮素水平继续升高,但对照组只是略有上升,而实验组显著高于对照组(t=5.134,P < 0.01);T3期对照组患者血浆内皮素水平开始下降,而实验组患者内皮素水平略有下降,但仍保持在较高水平,两组间比较差异有统计学意义(t=6.627,P < 0.01);T4期两组患者血浆内皮素水平均恢复至T0期水平,两组间比较差异无统计学意义(t=1.917,P > 0.05)。
从表 2可以看出:对照组患者血浆CGRP水平在围手术期变化不明显,T0期实验组患者血浆CGRP水平略高于对照组,但差异无统计学意义(t=0.937,P > 0.05);T1期对照组患者血浆CGRP水平升高,而实验组却见下降,两组间比较差异有统计学意义(t=4.084,P < 0.05);T2期对照组患者血浆CGRP水平较T1期略有降低,而实验组则开始升高,但两组间比较差异无统计学意义(t=0.456,P > 0.05);T3期两组患者血浆CGRP水平均有升高,而且实验组(t=4.085,P < 0.05);T4期两组患者血浆CGRP水平均较T0期有所升高,但两组间比较差异无统计学意义(t=0.475,P > 0.05)。
老年患者胆囊切除术围手术期血浆内皮素和降钙素基因相关肽水平分析
Analysis of plasma edothelin and calcitonin gene-related peptide in aged patients undergoing laparoscopic cholecystectomy
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摘要:
目的 观察老年患者胆囊切除术围手术期血浆内皮素和降钙素基因相关肽(CGRP)水平的变化,了解内皮素和CGRP在老年患者手术麻醉应激反应中的作用。 方法 选取择期行胆囊切除术的患者60例,根据年龄分为实验组和对照组,其中,实验组年龄 > 65岁,平均年龄(44±17)岁;对照组年龄 < 65岁,平均年龄(71±5)岁,两组病例数均为30例。分别于手术麻醉前(T0期)、气管插管后(T1期)、胆囊切除时(T2期)、术毕(T3期)、术后24 h(T4期)抽取静脉血,采用放射免疫分析法测定血浆中内皮素和CGRP水平。 结果 T0期实验组血浆中内皮素水平高于对照组,但两组间比较差异无统计学意义(t=0.971,P>0.05);T1期两组患者血浆中内皮素水平均逐渐升高,其中实验组增高明显(t=4.258,P<0.05);T2期两组患者血浆中内皮素水平继续升高,实验组增高明显(t=5.134,P<0.01);T3期对照组患者血浆内皮素水平开始降低,而实验组患者内皮素水平继续升高(t=6.627,P<0.01);T4期两组患者内皮素水平均恢复到T0期水平,两组间比较差异无统计学意义(t=1.917,P>0.05)。对照组患者血浆CGRP水平在围手术期变化不明显,而实验组患者血浆中CGRP水平在T0期后降低,T2期又逐渐增高,到T3期达到最高。两组患者在T1期和T3期的CGRP水平相比,差异有统计学意义(t=4.084和t=4.085,P均<0.05)。 结论 老年患者胆囊切除术围手术期内皮素和CGRP水平变化均较青壮年患者显著,内皮素的变化尤为明显,围手术期危险更大。 Abstract:Objective To investigate the effects of laparoscopic cholecystectomy on the plasma levels of endothelin and calcitonin gene-related peptide(CGRP)in elderly patients. Methods Sixty patients undergoing elective laoaroscopic cholecystectomy were divided into < 65 years old group and > 65 years old group according to their ages(30 cases in each group). The plasma levels of endothelin and CGRP were measured before surgery, after intubation, at the time of gallbladder removal, immediately after surgery and 24 hours after surgery by radioimmunoassay. Results There was no significant difference in endothelin levels between the two groups before the surgery (t=0.971, P > 0.05). The endothelin levels in both groups gradually increased after the intubation, but more significantly in the > 65 years old group(t=4.258, P < 0.05). The increased endothelin levels were maintained during the surgery in both groups, but they were higher in the > 65 years old group(t=5.134, P < 0.01). When the surgery was completed, the level of endothelin in the > 65 years old group continued to increase, but it decreased in the < 65 years old group, and there was significantly difference between the two groups(t=6.627, P < 0.01). Endothelin levels in both groups at 24 hours after the surgery returned to the levels before surgery, and there was no significant difference between the two groups (t=1.917, P > 0.05). The CGRP levels had not significantly changed during the perioperative period in the < 65 years old group. In the > 65 years old group, CGRP levels decreased after anaesthesia, but increased during the surgery, and then reached the highest level at the time of the surgery completed. CGRP levels were significant difference between the two groups after intubation and immediately after surgery(t=4.084 and t=4.085, P < 0.05). Conclusion The levels of endothelin and CGRP had significantly changed elderly patients than those in young patients, especially for endothelin. -
Key words:
- Cholecystectomy /
- Aged /
- Anaesthesia /
- Calcitonin gene-related peptide /
- Endothelins
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表 1 对照组与实验组胆束疾病患者围手术期血浆内皮素水平
(x±s,pg/ml) 时期 T0期 T1期 T2期 T3期 T4期 对照组(< 65岁) 83.63±11.87 85.60±12.43 87.93±14.76 84.48±12.43 85.09±17.19 实验组(> 65岁) 87.15±15.91 100.46±14.52 114.23±23.86 110.73±17.78 95.11±22.89 t值 0.971 4.258 5.134 6.627 1.917 P值 0.583 0.024 0.008 0.001 0.283 表 2 对照组与实验组胆束疾病患者围手术期血浆降钙素基因相关肽水平
(x±s,pg/ml) 时期 T0期 T1期 T2期 T3期 T4期 对照组(< 65岁) 80.63±12.07 90.38±11.06 88.15±17.22 88.96±18.14 89.50±9.13 实验组(> 65岁) 83.85±14.44 75.48±16.64 86.17±16.39 110.23±22.01 87.54±20.68 t值 0.937 4.084 0.456 4.085 0.475 P值 0.595 0.030 0.796 0.030 0.787 -
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