术中综合改良措施对大隐静脉曲张患者血流动力学与术后应激反应的影响

Effect of intraoperative comprehensive improvement measures on hemodynamics and postoperative stress response in patients with great saphenous varicose

目的探讨术中综合改良措施对大隐静脉曲张(GSV)患者血流动力学与术后应激反应的影响。方法收集2021年1月至2023年12月于首都医科大学附属北京积水潭医院接受手术治疗的86例GSV患者的临床资料。根据干预方式的不同将患者分为常规组(采用常规术中干预措施)和改良组(采用术中综合改良措施),每组43例。比较两组患者的手术指标、手术默契度、术后恢复进程、不同时刻[麻醉诱导前(T_(0))、手术10 min(T_(1))、术毕即刻(T_(2))]血流动力学指标、手术前后应激反应指标[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、手术前后凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)水平、D-二聚体(D-D)]、术后并发症的发生情况及治疗情况。结果改良组患者的手术时间短于常规组患者,术中出血量低于常规组患者,手术默契度评分高于常规组患者,出院时间、患肢酸胀感消失时间和患肢沉重麻木感消失时间均短于常规组患者,差异均有统计学意义(P﹤0.05)。两组患者T_(0)、T_(1)时的心率和平均动脉压比较,差异均无统计学意义(P﹥0.05);改良组患者T_(2)时的心率、平均动脉压均低于常规组患者,差异均有统计学意义(P﹤0.05)。术后1 d,改良组患者的CRP、IL-6、TNF-α水平均低于常规组患者,PT、APTT、TT均长于常规组患者,FIB、D-D水平均低于常规组患者,差异均有统计学意义(P﹤0.05)。改良组患者术后并发症的总发生率为4.65%(2/43),低于常规组患者的23.26%(10/43),差异有统计学意义(P=0.013)。结论术中综合改良措施可有效减轻GSV患者术中血流动力学波动,从而降低术后炎性应激反应与血液高凝反应程度,更好地保障患者的手术安全性。

Objective To explore the effect of intraoperative comprehensive improvement measures on hemodynamics and postoperative stress response in patients with great saphenous varicose(GSV).Method The clinical data of 86 patients with GSV who underwent surgical treatment at Beijing Jishuitan Hospital,Capital Medical University from January 2021 to December 2023 were collected.According to different intervention methods,the patients were divided into routine group(using conventional intraoperative intervention measures)and improvement group(using intraoperative comprehensive improvement measures),with 43 cases in each group.The surgical indicators,surgical cooperation,postoperative recovery process,hemodynamic indicators at different time points[before anesthesia induction(T_(0)),10 minutes after surgery(T_(1)),and immediately after surgery(T_(2))],stress response indicators[tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)]before and after surgery,coagulation function indicators[activated partial thrombin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(FIB)level,D-dimer(D-D)level]before and after surgery,incidence of postoperative complications and treatment outcomes between two groups of patients were compared.Result The surgery time of the improvement group patients was shorter than that of the routine group patients,the intraoperative bleeding volume was lower than that of the routine group patients,the surgical cooperation score was higher than that of the routine group patients,and the discharge time,the disappearance time of soreness and swelling sensation in the affected extremity,and the disappearance time of heaviness and numbness sensation in the affected extremity were all shorter than those of the routine group patients,and the differences were statistically significant(P<0.05).There were no statistically significant differences in heart rate and mean arterial pressure between the two groups of patients at T_(0) and T_(1)(P>0.05);the heart rate and mean arterial pressure of the improvement group patients at T_(2) were lower than those of the routine group patients,and the differences were statistically significant(P<0.05).One day after surgery,the average levels of CRP,IL-6,TNF-αin the improvement group were lower than those in the routine group,PT,APTT,TT were longer than those in the routine group,FIB,D-D levels were lower than those in the routine group,and the differences were statistically significant(P<0.05).Conclusion Intraoperative comprehensive improvement measures can effectively alleviate hemodynamic fluctuations in patients with GSV,thereby reducing the degree of postoperative inflammatory stress response and hypercoagulability in blood,and better ensuring the safety of surgery for patients.