酮咯酸氨丁三醇超前镇痛对儿童下腹腔镜手术应激反应的影响

The Effect of Ketorolac Preemptive Analgesic on the Infants' Laparoscopy Postoperative Stress Response

目的:研究酮咯酸氨丁三醇超前镇痛对儿童下腹腔镜手术应激反应及血浆血栓素A2(TXA2)和血小板颗粒膜蛋白(GMP140)水平的影响。方法:将60例2~12岁ASAⅠ~Ⅱ级择期行下腹手术的患儿以抽签法随机分为观察组和对照组各30例,观察组给予酮咯酸氨丁三醇进行超前镇痛,对照组不给予药物进行超前镇痛,比较两组患儿的应激反应、氧化损伤、血小板活化、不良反应情况。结果:(1)观察组术后30 min、6 h皮质激素、肾上腺素、去甲肾上腺素水平均低于对照组(P均<0.05),而术后12 h上述指标与对照组比较差异无统计学意义(P>0.05);(2)观察组术后30 min GMP140水平低于对照组(P<0.05);(3)观察组不良反应发生率6.67%(2/30),低于对照组的13.33%(4/30)。结论:对于儿童下腹腔镜手术,采用酮咯酸氨丁三醇超前镇痛能有效抑制应激反应和血小板激活,同时降低不良反应发生率。

Objective： To study the effect of ketorolac preemptive analgesic on the infants＇ laparoscopy postoperative stress response and levels of thromboxane A2（ TXA-2） and platelet granular membrane protein 140（ GMP140）. Methods： The study had two groups：observation and control groups. The ketorolac was used in observation group for preemptive analgesic and no preemptive analgesic for control group. Sixty cases of 2 to 12 years old infants which were prepared to laparoscopy with ASAⅠ-Ⅱ grade were divided into the two groups randomly,each group with 30 cases. The postoperative stress response,oxidative damage,platelet activation and adverse reactions were compared. Results：（ 1） The levels of cortisol,epinephrine,norepinephrine in observation group were significantly lower than control group at 30 min and 6 h（ P〈0.05）. However,there were no significantly differences at 12 h（ P〈0.05）.（ 2） The level of GMP-140 in observation group was significantly lower than control group at 30 min（ P〈0.05）.（ 3） The adverse reaction rate of observation group was lower than control group. Conclusion： The postoperative stress response and platelet activation can be inhibited by the application of ketorolac preemptive analgesic on infants＇ laparoscopy. At the same time,the adverse reaction rate was also significantly lower too.