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

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（T33期）、术后24h（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）；R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．rn期水平，两组间比较差异无统计学意义（拄1．917，P〉025）。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Tn期后降低，T2期又逐渐增高，到B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（f=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。

Objective To investigate the effects of laparoscopic cholecystectomy on the plasma levels of endothelin and calcitonin gone-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 siznificant difference between the two erouDs after intubation and immediatelv 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.