氧化亚氮对HIFU治疗患者FHb及ICAM-1含量的影响

Effects of N_2O on the content of FHb and ICAM-1 in HIFU treatment patients

目的观察氧化亚氮（N2O）对高强度聚焦超声（HIFU）治疗患者血清游离血红蛋白（FHb）及细胞间黏附分子1（ICAM-1）含量的影响,探讨其组织损伤的作用机制。方法将50例原发性肝癌行HIFU治疗的患者（ASAⅠ-Ⅱ级）,分为对照组（C组）与试验组（N组）,每组25例。两组均使用全身麻醉方式,C组采用全凭静脉麻醉,N组采用静吸复合麻醉,两组麻醉诱导方式相同,N组麻醉维持在C组基础上吸入N2O。分别在麻醉前（T1）、手术前（T2）、术中第1小时（T3）、第2小时（T4）、第3小时（T5）,及术后24h（T6）抽取桡动脉血,采用类过氧化物酶反应法和双抗体夹心ELISA法检测血清中FHb及ICAM-1含量;用HIFU治疗仪超声显像系统测量两组患者术前、术后腹壁厚度值。结果随着手术过程中麻醉时间的延长,血清中FHb及ICAM-1含量之较前均明显增多（P〈0.05）;同一时间点,与C组相比,N组FHb和ICAM-1增多明显（P〈0.05）;与C组相比,N组术前、术后腹壁厚度值变化明显增加（P〈0.05）。结论 N组在HIFU治疗过程中,机体产生更多的FHb及ICAM-1,继发引起腹壁皮肤明显肿胀,这可能与N2O增强超声空化效应有关。

Objective To observe the effect of nitrous oxide（N2O）on the content of serum free hemoglobin,and intercellular adhesion molecule-1（ICAM-1）of patients with HIFU Therapy,and investigate its action of tissue damage mechanism.Methods50 patients with primary liver cancer undergoing HIFU surgery（ASAⅠ- Ⅱ class）were randomly divided into control group（group C）and experimental group（group N）,25 patients of each group.General anesthesia method was used in both two groups,group C was by total intravenous anesthesia,group N was adopted intravenous-inhalation anesthesia.both two groups was adopted the same anesthesia induction method.anesthesia maintain of group N was joined N2 O on the basis of group C.both two groups were draw blood from the radial artery at the points of before anesthesia（T1）,before operation（T2）,1h（T3）,2h（T4）,3h（T5）after intraoperative,and 24 hafter operation（T6）,peroxidase reaction test and double antibody sandwich ELISA method were adopted to detect the content of Fhb value and ICAM-1;ultrasonography system of HIFU therapeutic instrument was used to measure the abdominal wall thickness of patients before and after operation.Results The content of FHb and ICAM-1in serum were significantly increased after operation than before with the anesthesia time（P〈0.05）;compared with group C,group N increased obviously at the same point in time（P〈0.05）;preoperative and postoperative abdominal wall thickness value of group N was increased significantly（P〈0.05）.Conclusion It may be connected with N2 O enhanced ultrasound cavitation effect that the body produces more FHb and ICAM-1of group N in HIFU treatment,and induces abdominal wall skin markedly swollen.