老年患者腹腔镜胆囊切除术后应激反应及疲劳综合征的临床观察

Clinical observation of postoperative stress response and fatigue syndrome of laparoscopic cholecystectomy on elderly patients

目的:探讨老年患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的应激反应及疲劳综合征的表现。方法:回顾分析2008年10月至2012年10月为160例老年患者行LC的临床资料,根据患者病情决定手术方式,并将其分为腹腔镜组与开腹组,每组80例,分别于术前及术后第1天、第2天、第3天测定两组患者皮质醇、C反应蛋白(C reactive protein,CRP)、中性粒细胞、白细胞(white blood cell,WBC)、白介素-6(interleukin-6,IL-6)及IL-10水平,并对比分析两组患者手术情况及术后疲劳评分。结果:两组手术时间差异无统计学意义(P>0.05),两组术中出血量、术后住院时间差异有统计学意义(P<0.05)。与术前相比,两组患者术后IL-6、IL-10及CRP水平差异均有统计学意义(P<0.05);术后中性粒细胞、WBC两组患者均有所增高,差异有统计学意义(P<0.05);皮质醇均较术前有所降低,差异有统计学意义(P<0.05)。两组间相比,腹腔镜组IL-6、CRP水平较开腹组低,差异有统计学意义(P<0.05);但IL-10水平较开腹组高(P<0.05);两组患者皮质醇增高程度差异有统计学意义(P<0.05)。两组术前疲劳评分差异无统计学意义(P>0.05),与术前相比,两组患者术后疲劳评分差异均有统计学意义(P<0.05),且两组间相比差异亦有统计学意义(P<0.05)。结论:老年患者脏器功能呈衰退表现,手术时容易出现明显的应激反应,LC患者创伤小,可显著减轻创伤所致的应激反应,同时患者术后疲劳综合征减轻,康复快。

Objective： To discuss the postoperative stress response and fatigue syndrome of laparoscopic cholecystectomy on elderly patients. Methods： Clinical data of 160 elderly patients from Oct. 2008 to Oct. 2012 were analyzed retrospectively. Surgical procedures were determined according to conditions of patients and patients were divided into laparoscopy group（ n = 80） and open group（ n =80）. Indicators such as cortisol,C-reactive protein（ CRP）,neutrophil,white blood cell（ WBC）,interleukin-6（ IL-6） and interleukin-10（ IL-10） were inspected both preoperatively and postoperatively（ the 1st,2nd and 3rd day after operation）. Conditions of operation and postoperative fatigue score were comparatively analyzed between the 2 groups. Results： No significant differences were found in mean operation time between 2 groups（ P 0. 05）. There were significant differences in intraoperative blood loss and postoperative hospital stay between 2 groups（ P 0. 05）. Compared with preoperative level,there were significant differences in postoperative IL-6,IL-10 and CRP between 2 groups（ P 0. 05）; postoperative levels of neutrophil and WBC increased in both groups with statistical significance（ P 0. 05）. Levels of cortisol reduced compared with preoperative value in both groups with statistical significance（ P 0. 05）. IL-6 and CRP of laparoscopy group were lower than open group with a statistical significance（ P 0. 05）; but IL-10 of laparoscopy group was higher than open group（ P 0. 05）; there was a significant difference in level of postoperative increased cortisol between 2 groups（ P 0. 05）. No significant differences were found in preoperative fatigue score between 2 groups（ P 0. 05）. Compared with preoperative value,there was a significant difference from postoperative fatigue score in each group（ P 0. 05）,and with a statistical significance between 2 groups（ P 0. 05）. Conclusions： Function of elderly patients＇ organ is in decline,which easily leads to stress response during operation. Laparoscopic cholecystectomy,which has less trauma and quicker recovery,can significantly reduce the stress response caused by surgical trauma,and reduce postoperative fatigue syndrome of elderly patients.