超声引导下腹横肌平面麻醉对无张力疝修补术患者血清犬尿喹啉酸和色氨酸水平的影响
|
摘要
目的:研究超声引导下腹横肌平面麻醉(TAPB)对无张力疝修补术患者血清犬尿喹啉酸(KYNA)和色氨酸(TRP)水平的影响。方法:选择2014年1月至2017年1月本院收治的100例单侧腹股沟斜疝患者。按随机数字表法分为观察组和对照组,每组50例。对照组实施全身麻醉,观察组在对照组的基础上行双侧超声引导下TAPB。比较两组术后疼痛视觉模拟量表(VAS)评分,血清KYNA、TRP、干扰素(IFN)-γ和白介素(IL)-6水平及不良反应发生率。结果:观察组静息状态和咳嗽时的VAS评分及血清KYNA、IFN-γ、IL-6水平均显著低于对照组,TRP水平显著高于对照组(均P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:超声引导下TAPB能够减轻无张力疝修补术患者术后疼痛,且对患者术后血清KYNA、TRP水平影响小,安全性好。
Objective:To explore the ultrasound-guided local anesthesia on serum kynurenie acid(KYNA)and tryptophan(TRP)levels in patients undergoing tension-free hernioplasty.Methods:A total of 100 patients with unilateral inguinal hernia in our hospital from January 2014 to January 2017 were selected,and randomized to receive either general anaesthesia only(control group,50 cases)or combined with bilateral ultrasound-guided transverse abdominal muscle plane block(observation group,50 cases).The visual analogue scale(VAS)score and the serum levels of KYNA,TRP,interferon(IFN)-γand interleukin(IL)-6 as well as the incidence of adverse reactions were detected and compared.Results:The resting and cough VAS scores and the serum levels of KYNA,IFN-γand IL-6 in the observation group were significantly lower than those in the control group,while the TRP level was notably higher(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Ultrasoundguided local anesthesia could relieve pain in patients with tension-free hernioplasty and had less impact on the levels of KYNA and TRP,and was safe.
Objective:To explore the ultrasound-guided local anesthesia on serum kynurenie acid(KYNA)and tryptophan(TRP)levels in patients undergoing tension-free hernioplasty.Methods:A total of 100 patients with unilateral inguinal hernia in our hospital from January 2014 to January 2017 were selected,and randomized to receive either general anaesthesia only(control group,50 cases)or combined with bilateral ultrasound-guided transverse abdominal muscle plane block(observation group,50 cases).The visual analogue scale(VAS)score and the serum levels of KYNA,TRP,interferon(IFN)-γand interleukin(IL)-6 as well as the incidence of adverse reactions were detected and compared.Results:The resting and cough VAS scores and the serum levels of KYNA,IFN-γand IL-6 in the observation group were significantly lower than those in the control group,while the TRP level was notably higher(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Ultrasoundguided local anesthesia could relieve pain in patients with tension-free hernioplasty and had less impact on the levels of KYNA and TRP,and was safe.
引文
[1]刘晓晴,殷彩燕,段晓丽,等.老年腹股沟疝无张力修补术中不同麻醉方法的效果比较[J].宁夏医科大学学报,2015,37(12):1453-1454.
[2]庄亚强.老年腹股沟疝的无张力修补术(附206例分析)[J].广西医科大学学报,2006,23(4):667-667.
[3]丁战伟,李志彬.两种不同的麻醉方式下行无张力疝修补治疗老年腹股沟疝的临床比较[J].中华疝和腹壁外科杂志电子版,2015,9(5):29-31.
[4]何清泉,陈建树,杨海峰.七氟烷吸入麻醉对腹腔镜胆囊切除术患者应激反应和犬尿喹啉酸水平的影响[J].中国药师,2016,19(6):1102-1104.
[5]王道涵,王素梅,卫利,等.犬尿酸代谢途径异常与中枢神经系统疾病[J].生理科学进展,2016,47(1):43-46.
[6]SMITH S R,DRAGANIC B,POCKNEY P,et al.Transversus abdominis plane blockade in laparoscopic colorectal surgery:a double-blind randomized clinical trial[J].International Journal of Colorectal Disease,2015,30(9):1237-1245.
[7]中华医学会外科学分会疝和腹壁外科学组.成人腹股沟疝诊疗指南(2014年版)[J].中国实用外科杂志,2014,52(6):484-486.
[8]PEDRAZZANI C,MENESTRINA N,MORO M,et al.Local wound infiltration plus transversus abdominis plane(TAP)block versus local wound infiltration in laparoscopic colorectal surgery and ERAS program[J].Surgical Endoscopy,2016,30(11):5117-5125.
[9]高威,董明,周建平,等.无张力疝修补术后慢性疼痛临床相关因素分析[J].中国实用外科杂志,2015,35(7):770-772.
[10]王利,郑璘,王万臣,等.腹横肌平面阻滞对局部麻醉下腹股沟疝修补术的疗效分析[J].中国现代医学杂志,2015,25(20):96-100.
[11]修雪莉,董斌,麦丽尧,等.超声引导下腹横肌平面阻滞用于小儿腹股沟斜疝修补术后镇痛效果观察[J].医药前沿,2016,6(1):152-153.
[12]MATYSIK-WOZNIAK A,PADUCH R,TURSKI W A,et al.Effects of tryptophan,kynurenine and kynurenic acid exerted on human reconstructed corneal epithelium in vitro[J].Pharmacological Reports,2017,69(4):722-729.
[13]焦艳玲,赵俊锦,陈力,等.七氟醚吸入麻醉对心脏手术患者血清犬尿喹啉酸水平的影响[J].实用药物与临床,2016,19(8):975-977.
[14]DE BJ,LIM CK,GUILLEMIN GJ.Progesterone alters kynurenine pathway activation in IFN-γ-activated macrophages-relevance for neuroinflammatory diseases[J].International Journal of Tryptophan Research Ijtr,2016,9(9):89-93.
[15]WANG Q,LIU D,SONG P,et al.Tryptophan-kynurenine pathway is dysregulated in inflammation,and immune activation[J].Frontiers in Bioscience,2015,20(7):1116-1143.
[2]庄亚强.老年腹股沟疝的无张力修补术(附206例分析)[J].广西医科大学学报,2006,23(4):667-667.
[3]丁战伟,李志彬.两种不同的麻醉方式下行无张力疝修补治疗老年腹股沟疝的临床比较[J].中华疝和腹壁外科杂志电子版,2015,9(5):29-31.
[4]何清泉,陈建树,杨海峰.七氟烷吸入麻醉对腹腔镜胆囊切除术患者应激反应和犬尿喹啉酸水平的影响[J].中国药师,2016,19(6):1102-1104.
[5]王道涵,王素梅,卫利,等.犬尿酸代谢途径异常与中枢神经系统疾病[J].生理科学进展,2016,47(1):43-46.
[6]SMITH S R,DRAGANIC B,POCKNEY P,et al.Transversus abdominis plane blockade in laparoscopic colorectal surgery:a double-blind randomized clinical trial[J].International Journal of Colorectal Disease,2015,30(9):1237-1245.
[7]中华医学会外科学分会疝和腹壁外科学组.成人腹股沟疝诊疗指南(2014年版)[J].中国实用外科杂志,2014,52(6):484-486.
[8]PEDRAZZANI C,MENESTRINA N,MORO M,et al.Local wound infiltration plus transversus abdominis plane(TAP)block versus local wound infiltration in laparoscopic colorectal surgery and ERAS program[J].Surgical Endoscopy,2016,30(11):5117-5125.
[9]高威,董明,周建平,等.无张力疝修补术后慢性疼痛临床相关因素分析[J].中国实用外科杂志,2015,35(7):770-772.
[10]王利,郑璘,王万臣,等.腹横肌平面阻滞对局部麻醉下腹股沟疝修补术的疗效分析[J].中国现代医学杂志,2015,25(20):96-100.
[11]修雪莉,董斌,麦丽尧,等.超声引导下腹横肌平面阻滞用于小儿腹股沟斜疝修补术后镇痛效果观察[J].医药前沿,2016,6(1):152-153.
[12]MATYSIK-WOZNIAK A,PADUCH R,TURSKI W A,et al.Effects of tryptophan,kynurenine and kynurenic acid exerted on human reconstructed corneal epithelium in vitro[J].Pharmacological Reports,2017,69(4):722-729.
[13]焦艳玲,赵俊锦,陈力,等.七氟醚吸入麻醉对心脏手术患者血清犬尿喹啉酸水平的影响[J].实用药物与临床,2016,19(8):975-977.
[14]DE BJ,LIM CK,GUILLEMIN GJ.Progesterone alters kynurenine pathway activation in IFN-γ-activated macrophages-relevance for neuroinflammatory diseases[J].International Journal of Tryptophan Research Ijtr,2016,9(9):89-93.
[15]WANG Q,LIU D,SONG P,et al.Tryptophan-kynurenine pathway is dysregulated in inflammation,and immune activation[J].Frontiers in Bioscience,2015,20(7):1116-1143.