激素在急性结石性胆囊炎高龄患者围手术期中的应用研究

Application Analysis of Glucorticosteroids during Perioperation Period in Senile Patients who underwent Emergent Operation For Acute Calculous Cholecystitis

目的探讨糖皮质激素(GC)在急性结石性胆囊炎高龄患者急诊手术围手术期中应用的有效性和安全性。方法将我院普外科自2008年1月～2012年6月收治47例急性结石性胆囊炎急诊施行手术治疗的高龄患者随机分为常规处理组(对照组)22例和氢化可的松处理组(GC组)25例。对照组围手术期给予常规处理;观察组除了常规处理以外,术中给予氢化可的松300 mg,术后继续给予300 mg.d-1,3～4 d后停药。观察两组间常规治疗干预强度及时间、术后恢复差异、感染及全身炎反应控制效果、并发症发生及病死率。结果两组患者术后3天7天CTP评分比较,GC组低于对照组,差异有统计学意义(P<0.05);GC组肝功能术后恢复正常时间、全身炎症反应控制时间少于对照组,两组比较差异有统计学意义(P<0.05);两组术后并发症发生率比较,GC组低于对照组,差异有统计学意义(P<0.05)。结论在急性结石性胆囊炎高龄患者急诊手术围手术期短期持续给予糖皮质激素处理,可有效减轻患者术后肝功能损害、控制全身炎症反应、减少术后并发症的发生,不增加重度感染风险、术后病死率。

Objective To investigate the efficacy and safety of glucorticosteroids in perioperative therapy of senile patients with acute calculous cholecystitis（AAC）.Methods 47 senile patients with ACC from Jan.2008 to Jun 2012 were randomly divided into the GCgroup（n=25） and the control group（n=22）.Control group received conventional treatment in perioperative period,while the GC group was given additional hydrocortisone treatment： Intraoperative dosage is 300mg,and the postoperative dosage is 300mg·d^-1,after 3 or 4 days stop the treatment.Observe the differences in intensity and time of conventional treatment,postoperative recovery between the two groups,effect of infection control and systemic inflammation reaction,incidence of complications and mortality.Results CTP scores of the two groups after surgery 3 and 7 days were compared,GC group was significantly lower than the control group,the difference was statistically significant（P〈0.05）.GC group＇s incidence of postoperative complications was significantly lower than the control group,the difference was statistically significant（P〈0.05）.Conclusion A short-term of perioperative glucocorticoid treatment in elderly patients with emergency surgery for AAC,can effectively reduce postoperative liver dysfunction,can effectively reduce postoperative liver dysfunction,actively control the systemic inflammatory response,reduce the incidence of post-operative complications,and does not increase the risk of severe infection and postoperative mortality.