肋间神经冷冻术联合血必净对开胸患者术后血浆白细胞介素6、C反应蛋白的影响及临床观察
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摘要
开胸术后病人的并发症主要有肺不张、低氧血症、肺部感染、心律失常等,上述并发症均与术后患者全身炎性反应程度及切口疼痛有密切关系。白细胞介素6(IL-6)及C反应蛋白(CRP)是炎性反应中两个主要的介质,二者在患者炎性反应的发生、发展的过程中起到十分重要的作用,近来的研究表明,围手术期IL-6及CRP的变化与外科术后并发症的发生有密切关系。由于开胸术后切口疼痛,使病人胸廓运动受限,呼吸功能减弱,导致肺不张、肺炎等肺部并发症的发生,又由于肺部并发症的发生,进而引起低氧血症,心律不齐,使术前隐匿性缺血性心脏病突然发作,这些并发症直接或者间接的又导致了患者血浆炎性介质水平升高,从而加剧患者的全身炎性反应(SIRS)程度,甚至造成患者多器官功能不全(MODS)。因此,术后降低患者血浆中炎性介质水平及有效的镇痛对患者的预后有十分积极的作用。肋间神经冷冻术作为开胸术后镇痛方式其操作简便,安全有效,已被临床广泛应用。中药血必净作为有效的促炎因子拮抗剂,广泛应用于脓毒血症及多脏器功能不全综合征的治疗,在肺部疾病及肾移植术后也有应用。但未见二者联合用于开胸术后患者的研究。
目的通过肋间神经冷冻术联合血必净对开胸患者术后血浆白细胞介素6、C反应蛋白的影响及临床观察,探讨这一中西医结合方法对开胸术患者炎性介质的影响及其临床意义。
方法选取手术部位接近、手术方式相同的病例,尽量缩小由于手术因素造成的观测指标差异,因此选择左侧开胸行食管癌切除术患者60例,随机分为3组,每组20例,对照组,肋间神经冷冻组(冷冻组),肋间神经冷冻联合血必净组(联合组)。采用视觉模拟评分法(VAS),记录术后48h患者的VAS评分情况。抽取患者术前1d、术后2h、6h、24h、3d及6d外周静脉血测定IL-6浓度水平,抽取患者术前1d、术后2h、24h、3d、6d外周静脉血测定CRP浓度水平,对测得的结果进行对比,观察不同方法对患者围手术期血浆IL-6及CRP浓度水平的影响。记录三组术后并发症的情况并进行比较,观察肋间神经冷冻术联合血必净对开胸术后并发症的影响。
结果各组术前1d血浆IL-6、CRP浓度无明显差异。开胸术后患者血浆IL-6、CRP浓度均明显高于术前水平,血浆IL-6浓度在开胸术后迅速升高,术后2h达到高峰,术后6h血浆IL-6浓度开始下降,术后3-6d血浆IL-6浓度回落至接近术前水平。而CRP浓度于术后2h无明显升高,术后1d显著升高,术后3-6d大幅回落,各组间IL-6、CRP浓度变化规律相似,但升高幅度不同。冷冻组患者术后各时相IL-6浓度低于对照组,且于术后2h、6h、24h测得IL-6浓度与对照组相比有显著差异(P＜0.05),联合组患者术后各时相IL-6浓度浓度低于对照组及冷冻组,且于术后2h、6d测得IL-6浓度与对照组相比有显著差异(P＜0.05),术后6h、24h、3d与对照组相比有非常显著差异(P＜0.01)。各组患者术后2h测得CRP浓度无统计学意义,冷冻组患者术后24h、3d测得CRP浓度低于对照组,有显著差异(P＜0.05),联合组患者术后24h、3d测得CRP浓度明显低于对照组,有非常显著差异(P＜0.01),术后6d测得CRP浓度低于对照组,有显著差异(P＜0.05)。术后48小时VAS记录结果:对照组为7.25±2.33,总止痛有效率:35%,冷冻组为2.1±2.22,总止痛有效率:95%,与对照组相比有非常显著差异(P＜0.01),联合组为2.25±2.24,总止痛有效率:90%,与对照组相比有非常显著差异(P＜0.01),与冷冻组相比无显著差异(P＞0.05)。对照组术后发生并发症者3例,并发症发病率为15%;冷冻组2例,并发症发病率为10%,低于对照组;联合组患者无术后并发症,并发症发病率为0,低于冷冻组和对照组,但各组间无统计学意义。
结论肋间神经冷冻术镇痛效果明显,同时可以降低患者手术后血浆中IL-6、CRP浓度水平,减少术后并发症的发生。肋间神经冷冻术联合血必净可进一步降低患者术后外周血中IL-6及CRP浓度水平,提示肋间神经冷冻术联合血必净这一中西结合的方法对预防开胸术后并发症起了有效的作用。
Complications after thoracotomy are mainly atelectasis, hypoxemia, pulmonary infection, arrhythmia, etc. These postoperative complications are closely related to systemic inflammatory response and the extent of incision pain. Interleukin-6 (IL-6) and C-reactive protein (CRP) are two major inflammatory response in the media, both in the inflammatory response in patients with the occurrence and development of the process has played a very important role, the recent study showed that perioperative IL-6 and CRP changes is closely related to the occurrence of postoperative complications. Because incision pain after thoracotomy, the Patient thoracic exercise is limited, decreased respiratory function, leading to pulmonary atelectasis, pneumonia, lung abscess, such as the occurrence of pulmonary complications, which cause hypoxemia , arrhythmias, so that preoperative occult ischemic heart disease sudden attack. Either directly or indirectly, these complications increase levels of inflammatory mediators, thereby exacerbating the inflammatory response in patients, cause multiple organ dysfunction (MODS). Therefore, lower plasma levels of inflammatory mediators and effective analgesia on the prognosis of patients has a very active role. Intercostal nerves cryoanalgesia after thoracotomy surgery as a way of its simple, safe and effective, has been widely used clinical. Xuebijing as an effective pro-inflammatory factor antagonist, is widely used in sepsis and multiple organ dysfunction syndrome treatment, as well as in lung disease, renal transplantation has been applied.
Objective Through the combined with intercostal nerves cryoanalgesia and Xuebijing on Post-thoracotomy patients with plasma IL-6, C-reactive protein and clinical observation, to explore the effect of this combination of Traditional Chinese Medicine with Western Medicine method for thoracotomy in patients with inflammatory mediators and their clinical significance.
Methods Selected close to the surgical site, surgical cases in the same surgical methods as to minimize the differences in observed indicators because of Surgical factors caused by, Therefore select line left thoracotomy in patients with esophageal carcinoma 60 cases, they were randomly divided into 3 groups, control group, cryoanalgesia group (frozen group), combined with cryoanalgesia and Xuebijing group (United group). Severity of pain was graded by Visual Analogue Scale (VAS), recorded after 48h in patients with VAS score situation. Plasma IL-6 concentration levels by peripheral venous blood in vitro were measured before 1d and at 2h, 6h, 24h, 3d and 6d after operation. Plasma CRP concentration levels by peripheral venous blood in vitro were measured before 1d and at 2h, 24h, 3d and 6d after operation, on the measured results were compared to observe the different methods effect of patient in perioperative plasma IL-6 and CRP concentration levels. Record three groups postoperative complications and compared. Observation of combined with Intercostal Nerves Cryoanalgesia and Xuebijing on the impact of complications after thoracotomy and clinical significance.
Results The day before surgery, each group preoperative plasma IL-6, CRP concentration was no significant difference. After thoracotomy in patients with plasma IL-6, CRP concentrations were significantly higher than preoperative. IL-6 level after operation in all patients was significantly higher than that before surgery, reach its peak at 2h after operation. At 6h after operation plasma IL-6 started to decline, after 3-6d plasma IL-6 dropped to close to preoperative levels. CRP level was no significant change at 2h after operation. CRP level at 1d after operation in patients of all groups was signifieantly higher than preoperative, 3-6 days after operation it's significant downturn. IL-6, CRP level were similar in each groups, but the increased rate were different. Patients with frozen group at each phase of the IL-6 levels below the control group, and at 2h, 6h, 24h after operation measured level of IL-6 has significantly differences with the control group (P<0.05). In united group patients the level of IL-6 at each phase is lower than the control group and the frozen group, and at 2h, 6d after operation measured level of IL-6 has signifieantly differences with the control group (P<0.05) .And at 6h, 24h, 3d after were very signifieantly different with control group (P<0.01) . At 2h after patients in each group detected no signifieantly difference in CRP, patients with frozen Group at after operation 24h, 3d measured level of CRP was lower than the control group (P<0.05) . In united group, postoperative 24h, 3d measured concentration of CRP was significantly lower than control group (P<0.01) . At 6d after operation measured concentrations of CRP was lower than the control group (P<0.05) . At 48h after operation, the VSA score of Control group was 7.25±2.33, the total effective rates were 35%. Frozen group was 2.1±2.22, and the total effective rates were 95%. There was significant difference between the frozen group and the control group (P<0.01) . United group was 2.25±2.24, the total effective rates were 90%. There was significant difference between the united group and the control group (P<0.01), with no difference between frozen group. Control group has three cases of postoperative complications in patients, the incidence of complications was 15%; frozen group has two cases, the incidence of complications was 10%, which is lower than the control group; United group without postoperative complications is lower than the frozen and control groups, but each group had no statistical significance.
Conclusion Freezing intercostalnerves during thoracotomy can effectively prevent postoperative chest pain, also can reduce post-operative plasma IL-6, CRP levels, reduce the occurrence of postoperative complications. Combined with intercostal nerves cryoanalgesia and Xuebijing can further reduce the peripheral blood of patients with IL-6 and CRP levels .Tips combined with Intercostal Nerves Cryoanalgesia and Xuebijing this Traditional Chinese medicine with Western Medicine method on prevention of complications after thoracotomy has been effective.
目的通过肋间神经冷冻术联合血必净对开胸患者术后血浆白细胞介素6、C反应蛋白的影响及临床观察,探讨这一中西医结合方法对开胸术患者炎性介质的影响及其临床意义。
方法选取手术部位接近、手术方式相同的病例,尽量缩小由于手术因素造成的观测指标差异,因此选择左侧开胸行食管癌切除术患者60例,随机分为3组,每组20例,对照组,肋间神经冷冻组(冷冻组),肋间神经冷冻联合血必净组(联合组)。采用视觉模拟评分法(VAS),记录术后48h患者的VAS评分情况。抽取患者术前1d、术后2h、6h、24h、3d及6d外周静脉血测定IL-6浓度水平,抽取患者术前1d、术后2h、24h、3d、6d外周静脉血测定CRP浓度水平,对测得的结果进行对比,观察不同方法对患者围手术期血浆IL-6及CRP浓度水平的影响。记录三组术后并发症的情况并进行比较,观察肋间神经冷冻术联合血必净对开胸术后并发症的影响。
结果各组术前1d血浆IL-6、CRP浓度无明显差异。开胸术后患者血浆IL-6、CRP浓度均明显高于术前水平,血浆IL-6浓度在开胸术后迅速升高,术后2h达到高峰,术后6h血浆IL-6浓度开始下降,术后3-6d血浆IL-6浓度回落至接近术前水平。而CRP浓度于术后2h无明显升高,术后1d显著升高,术后3-6d大幅回落,各组间IL-6、CRP浓度变化规律相似,但升高幅度不同。冷冻组患者术后各时相IL-6浓度低于对照组,且于术后2h、6h、24h测得IL-6浓度与对照组相比有显著差异(P＜0.05),联合组患者术后各时相IL-6浓度浓度低于对照组及冷冻组,且于术后2h、6d测得IL-6浓度与对照组相比有显著差异(P＜0.05),术后6h、24h、3d与对照组相比有非常显著差异(P＜0.01)。各组患者术后2h测得CRP浓度无统计学意义,冷冻组患者术后24h、3d测得CRP浓度低于对照组,有显著差异(P＜0.05),联合组患者术后24h、3d测得CRP浓度明显低于对照组,有非常显著差异(P＜0.01),术后6d测得CRP浓度低于对照组,有显著差异(P＜0.05)。术后48小时VAS记录结果:对照组为7.25±2.33,总止痛有效率:35%,冷冻组为2.1±2.22,总止痛有效率:95%,与对照组相比有非常显著差异(P＜0.01),联合组为2.25±2.24,总止痛有效率:90%,与对照组相比有非常显著差异(P＜0.01),与冷冻组相比无显著差异(P＞0.05)。对照组术后发生并发症者3例,并发症发病率为15%;冷冻组2例,并发症发病率为10%,低于对照组;联合组患者无术后并发症,并发症发病率为0,低于冷冻组和对照组,但各组间无统计学意义。
结论肋间神经冷冻术镇痛效果明显,同时可以降低患者手术后血浆中IL-6、CRP浓度水平,减少术后并发症的发生。肋间神经冷冻术联合血必净可进一步降低患者术后外周血中IL-6及CRP浓度水平,提示肋间神经冷冻术联合血必净这一中西结合的方法对预防开胸术后并发症起了有效的作用。
Complications after thoracotomy are mainly atelectasis, hypoxemia, pulmonary infection, arrhythmia, etc. These postoperative complications are closely related to systemic inflammatory response and the extent of incision pain. Interleukin-6 (IL-6) and C-reactive protein (CRP) are two major inflammatory response in the media, both in the inflammatory response in patients with the occurrence and development of the process has played a very important role, the recent study showed that perioperative IL-6 and CRP changes is closely related to the occurrence of postoperative complications. Because incision pain after thoracotomy, the Patient thoracic exercise is limited, decreased respiratory function, leading to pulmonary atelectasis, pneumonia, lung abscess, such as the occurrence of pulmonary complications, which cause hypoxemia , arrhythmias, so that preoperative occult ischemic heart disease sudden attack. Either directly or indirectly, these complications increase levels of inflammatory mediators, thereby exacerbating the inflammatory response in patients, cause multiple organ dysfunction (MODS). Therefore, lower plasma levels of inflammatory mediators and effective analgesia on the prognosis of patients has a very active role. Intercostal nerves cryoanalgesia after thoracotomy surgery as a way of its simple, safe and effective, has been widely used clinical. Xuebijing as an effective pro-inflammatory factor antagonist, is widely used in sepsis and multiple organ dysfunction syndrome treatment, as well as in lung disease, renal transplantation has been applied.
Objective Through the combined with intercostal nerves cryoanalgesia and Xuebijing on Post-thoracotomy patients with plasma IL-6, C-reactive protein and clinical observation, to explore the effect of this combination of Traditional Chinese Medicine with Western Medicine method for thoracotomy in patients with inflammatory mediators and their clinical significance.
Methods Selected close to the surgical site, surgical cases in the same surgical methods as to minimize the differences in observed indicators because of Surgical factors caused by, Therefore select line left thoracotomy in patients with esophageal carcinoma 60 cases, they were randomly divided into 3 groups, control group, cryoanalgesia group (frozen group), combined with cryoanalgesia and Xuebijing group (United group). Severity of pain was graded by Visual Analogue Scale (VAS), recorded after 48h in patients with VAS score situation. Plasma IL-6 concentration levels by peripheral venous blood in vitro were measured before 1d and at 2h, 6h, 24h, 3d and 6d after operation. Plasma CRP concentration levels by peripheral venous blood in vitro were measured before 1d and at 2h, 24h, 3d and 6d after operation, on the measured results were compared to observe the different methods effect of patient in perioperative plasma IL-6 and CRP concentration levels. Record three groups postoperative complications and compared. Observation of combined with Intercostal Nerves Cryoanalgesia and Xuebijing on the impact of complications after thoracotomy and clinical significance.
Results The day before surgery, each group preoperative plasma IL-6, CRP concentration was no significant difference. After thoracotomy in patients with plasma IL-6, CRP concentrations were significantly higher than preoperative. IL-6 level after operation in all patients was significantly higher than that before surgery, reach its peak at 2h after operation. At 6h after operation plasma IL-6 started to decline, after 3-6d plasma IL-6 dropped to close to preoperative levels. CRP level was no significant change at 2h after operation. CRP level at 1d after operation in patients of all groups was signifieantly higher than preoperative, 3-6 days after operation it's significant downturn. IL-6, CRP level were similar in each groups, but the increased rate were different. Patients with frozen group at each phase of the IL-6 levels below the control group, and at 2h, 6h, 24h after operation measured level of IL-6 has significantly differences with the control group (P<0.05). In united group patients the level of IL-6 at each phase is lower than the control group and the frozen group, and at 2h, 6d after operation measured level of IL-6 has signifieantly differences with the control group (P<0.05) .And at 6h, 24h, 3d after were very signifieantly different with control group (P<0.01) . At 2h after patients in each group detected no signifieantly difference in CRP, patients with frozen Group at after operation 24h, 3d measured level of CRP was lower than the control group (P<0.05) . In united group, postoperative 24h, 3d measured concentration of CRP was significantly lower than control group (P<0.01) . At 6d after operation measured concentrations of CRP was lower than the control group (P<0.05) . At 48h after operation, the VSA score of Control group was 7.25±2.33, the total effective rates were 35%. Frozen group was 2.1±2.22, and the total effective rates were 95%. There was significant difference between the frozen group and the control group (P<0.01) . United group was 2.25±2.24, the total effective rates were 90%. There was significant difference between the united group and the control group (P<0.01), with no difference between frozen group. Control group has three cases of postoperative complications in patients, the incidence of complications was 15%; frozen group has two cases, the incidence of complications was 10%, which is lower than the control group; United group without postoperative complications is lower than the frozen and control groups, but each group had no statistical significance.
Conclusion Freezing intercostalnerves during thoracotomy can effectively prevent postoperative chest pain, also can reduce post-operative plasma IL-6, CRP levels, reduce the occurrence of postoperative complications. Combined with intercostal nerves cryoanalgesia and Xuebijing can further reduce the peripheral blood of patients with IL-6 and CRP levels .Tips combined with Intercostal Nerves Cryoanalgesia and Xuebijing this Traditional Chinese medicine with Western Medicine method on prevention of complications after thoracotomy has been effective.
引文
1.Choussat R,Montalescot G,Collet JP,et al.Effectofprior ex-posure to Chlamydia pneumoniae,or eytomega-lovirus on the degree of inflammation and one-year prognosis of patients with unstable angina pectoris ornon-Qwave acutemyocardial infarction[J].Am J Cardiol,2000,86:379-384.
2.Pullicino EA,Carli F,Pode S,et al.The relationship between the circulating concentrations of interleukin 6(IL-6),tumor necrosis factor(TNF) and the acute phase response to elective surgery and accidental injury.Lymphokine Res,1990;9(2):231
3.Hoch RC,Rodriguez R,Manning T,et al.Effects of accidental trauma on cytokine and endotoxin production.Crit Care Med,1993;21(6):839
4.Sakamoto K,Aralawa H,Mita S,et al.Elevation of circulation interleukin-6 after surgery:factor influencing the serum level.Cytokine,1994;6(2):181
5.Maruszynski M,Pojda Z.Interleukin-6(IL-6)levels in the monitoring of surgical trauma,a comparison of serum IL-6concentrations in patients treated by cholecystectomy via laparotomy or laparoscopy.Surg Endosc,1995;9(8):882
6.Yoshizaki K.Clinical significance of cytokines-inter-leukin-6in disease.Rinsho Byori,1990;38(4):375
7.Baigrie RJ,Lamont PM,Kwiatkowski D,et al.Systemic cytokine re-sponse aftermajor surgery.Br J Surg,1992,79:757
8.Martin C,Boisson C,Haccou N,et al.Patterns of cytokine evolution(tumor necrosis factor-alpha and interleukin-6 after septic shock,hemorrhagic shock and severe trauma.Crit Care Med,1997;25(11):1813
9.田玉科,罗爱林,金士翱.重度创伤后血清肿瘤坏死因子α及白细胞介素6水平变化与感染性并发症的关系.中华实验外科杂志,1999;16(1):38
10.Ertel W,Faist E,Nestle C,et al.Kinetics of Inter-leukin-2 and interleukin-6 synthesis following major mechanical trauma.J Surg Res,1990;48(6):622
11.Svoboda P,Kantorova I,Ochmann J,et al.Dynamics of interleukin 1,2,6 and tumor necrosis factor alpha in multiple trauma patients.J Trauma,1994;36(3):336
12.陈志.国外医学临床生物化学与检验学分册,1994;15(3):9
13.周惠珍.中国实验临床免疫学杂志,1990;2(5):37
14.Cruickshand AM,Fraser WD,Burns HIG,et al.Response of selum interlukin-6 in patients undergoing electivesurgery[J].Clinical Science,1990,79:160-163.
15.Joris J,Cigarini I,Legrand M,et al.Metabolic and respiratory changes after cholecystectomy peformed via laparotomy or laparoscopy[J].Br J Anesthesia,1992,69:341-345.
16.Thompson D,et al.The value of acute phase proteinmeasurements in clinical practice[J]. Ann Clin Binchemm,1992,29:123-131.
17.褚银平,邓勇志,杨喜钟.食管癌贲门癌患者血清C-反应蛋白监测的临床价值.山西临床医学,1997;6(2):70-73
18.雪林.SIRS和MODS防治新对策的实验研究-血必净的药效学观察[J].中国危重病急救医学,1997;9(12):720-722
19.张畔,曹书华,崔克亮.血必净对多脏器功能障碍综合征单核细胞HILA-DR表达影响的研究[J].中国中西医结合急救杂志,2002;9(1):21-23.
20.王今达.脓毒症一感染性MODS的预防[J].中国危重病急救医学,1999,11:453-455.
21.李志军,孙元莹,吴云良,等.血必净注射液防治家兔应激性脏器损伤的研究[J].中国危重病急救医学,2006,18:105-108.
22.王蔼卿,曹书华.血必净对感染性MODS治疗中细胞因子及预后影响.天津医药,2007;35(7):529.
23.Nelson KM,Vincent RG,Bourke RS,et al.Intraoperative intercostal nerve freezing to prevent postthoracotomy pain[J].Ann Thorac Surg.1974;18(3):280-285.
24.赵凤瑞,主译.Pearson FG,Clement A,Hiebert CA等.主编.普通胸部外科学[M].沈阳:辽宁教育出版社,1999.65.
25.Towu EA,Roethe RA,Weissig MD,et al.One-day admissionfor lung lobectomy:an incidental result of a clinical pathway[J].Ann Thorac Surg,1998,65(3):803-806
26.绍洋,张英民,梁良,等.术后不同镇痛方法对神经内分泌和细胞因子的影响[J].中华麻醉学杂志,2000,20:532-535.
27.郎保平.陈国生,张宇.开胸术后不同镇痛方法的疗效比较分析[J].中国综合临床,2003,19(6):540-541.
28.赵凤瑞,田燕雏,刘德若,等.肋间神经冷冻止痛的实验及临床研究[J].中华外科杂志,2001,39(11):852.85.
29.Zhou L,Shao Z,Ou S.Cryoanalgesia:electrophysiology at different temperatures Cryobiology,2003,46:26.
30.Evans PJ.Cryoanalgesia The application of low temperatures to nerves to produceanaesthesia oranalgesia[j].Anaesthesia,1981,36(11):1003-1013.
31.Moorjan N,Zhao FR,Tian YC et al.Effects of cryoanalgesia on postthoracotomy pain and on the structure Of intercostal nerve:a human prospective randomized trial and a histological study.Eur J Cadlothoracie Surg,2001,20:502.
32.Maiwand Mo,Makey R,Rees A,et al.Cryoanalgesia after thoracotomy.Improvement of technique and review of 600 cases[J].J Thorac CardiovasSury,1986,92(2):291-295.
33.Tovar EA.Minimally invasive approach for pneumonectomy culrninating in an outpatient procedure.Chest,1998,114(5):1454-1458.
34.米智慧.JT-I型冷冻手术治疗机在胸科手术中的应用[J].中华实用医学,2004,6(13):80.
35.王今达,雪林.细菌、内毒素、炎性介质并治-治疗重症脓毒症的新对策[J].中国危重病急救医学,1998,10(6):323-325.
36.王筠默.中药药理学[M].上海:上海科技出版社.1985:73.
37.尹钟珠.血小板功能分析在活血化瘀研究中的应用[J].实用中西医结合杂志,1991,4(7):440.
38.王拥军 何士大.抗氧化中药的研究现状[J].中国中西医结合杂志,1996.16(5):312.
1.Lloyd Jw,Bamard JD,Glynn CJ.Cryoanalgesia.A new approach to pain relief[J].Lancet,1976,2(7992):932-934.
2.Nelson KM,Vincent RG,Bourke RS,et al.Intraoperative intercostal nerve freezing to prevent postthoracotomy pain[J].Ann Thorac Surg.1974.18(3):280-285.
3.赵凤瑞,田燕雏,刘德若,等.肋间神经冷冻止痛的实验及临床研究[J].中华外科杂志,2001,39(11):852-854.
4.Callesen T,Bech K,Thorup J.et al Cryoanalgesia:efect on posthemiorrhaphypaln[J].Anesth Analg,1998,87(4):896-899.
5.Evans PJ.Cryoanalgesia The application of low temperatures to nerves to produceanaesthesia oranalgesia[j].Anaesthesia,1981,36(11):1003-1013.
6.Evans PJ,Lloyd JW,Jack TM.Cryoanalgesia for intractable perineal pain[J].J R Soc Med,1981,74(11):804-809.
7.Glynn CJ,Lloyd JW,Bamard J D.Cryoanalgesia in the management of pain after thoracotomy[J].Thorax,1980,35(5):325-327.
8.Riopelle JM.Everson CN.Moustoukas P.et al.Cryoanalgesia:Present day status[J].Seminars in Anesthesia,1985,4:305-312.
9.Maiwand Mo,Makey R,Rees A,et al.Cryoanalgesia after thoracotomy.Improvement of technique and review of 600 cases[J].J Thorac CardiovasSury,1986,92(2):291-295.
10.赵凤瑞,田燕雏,刘德若,等.肋间神经冷冻止痛的实验及临床研究[J].中华外科杂志,2001,39(11):852.85.
11.Tovar EA.Minimally invasive approach for pneumonectomy culrninating in an outpatient procedure.Chest,1998,114(5):1454-1458.
12.Cr G,Am D,Ap T,et al.Longterm follow-up of cryoanalgesia for chronic thoracic pain[J].Regional Anesthesia And Pain Medicine,1993.18:46.
13.Orr I A,Keenan DJ,Dundee JW.Improved pain relief,after thoracotomy:use of cryoprobe and morphine infusion[J].Br Med J(Clin Res Ed),1981,283(6297):945-948.
14.赵凤瑞,主译.Pearson FG,Clement A,Hiebert CA等.主编.普通胸部外科学[M].沈阳:辽宁教育出版社,1999.65.
15.Tiippana E,Nilsson E,Kalso E.Post-thoracotomy pain after thoracic epidural analgesia:a prospective follow-up study[J].Acta Anaesthesiol Scand,2003,47(4):433-438.
2.Pullicino EA,Carli F,Pode S,et al.The relationship between the circulating concentrations of interleukin 6(IL-6),tumor necrosis factor(TNF) and the acute phase response to elective surgery and accidental injury.Lymphokine Res,1990;9(2):231
3.Hoch RC,Rodriguez R,Manning T,et al.Effects of accidental trauma on cytokine and endotoxin production.Crit Care Med,1993;21(6):839
4.Sakamoto K,Aralawa H,Mita S,et al.Elevation of circulation interleukin-6 after surgery:factor influencing the serum level.Cytokine,1994;6(2):181
5.Maruszynski M,Pojda Z.Interleukin-6(IL-6)levels in the monitoring of surgical trauma,a comparison of serum IL-6concentrations in patients treated by cholecystectomy via laparotomy or laparoscopy.Surg Endosc,1995;9(8):882
6.Yoshizaki K.Clinical significance of cytokines-inter-leukin-6in disease.Rinsho Byori,1990;38(4):375
7.Baigrie RJ,Lamont PM,Kwiatkowski D,et al.Systemic cytokine re-sponse aftermajor surgery.Br J Surg,1992,79:757
8.Martin C,Boisson C,Haccou N,et al.Patterns of cytokine evolution(tumor necrosis factor-alpha and interleukin-6 after septic shock,hemorrhagic shock and severe trauma.Crit Care Med,1997;25(11):1813
9.田玉科,罗爱林,金士翱.重度创伤后血清肿瘤坏死因子α及白细胞介素6水平变化与感染性并发症的关系.中华实验外科杂志,1999;16(1):38
10.Ertel W,Faist E,Nestle C,et al.Kinetics of Inter-leukin-2 and interleukin-6 synthesis following major mechanical trauma.J Surg Res,1990;48(6):622
11.Svoboda P,Kantorova I,Ochmann J,et al.Dynamics of interleukin 1,2,6 and tumor necrosis factor alpha in multiple trauma patients.J Trauma,1994;36(3):336
12.陈志.国外医学临床生物化学与检验学分册,1994;15(3):9
13.周惠珍.中国实验临床免疫学杂志,1990;2(5):37
14.Cruickshand AM,Fraser WD,Burns HIG,et al.Response of selum interlukin-6 in patients undergoing electivesurgery[J].Clinical Science,1990,79:160-163.
15.Joris J,Cigarini I,Legrand M,et al.Metabolic and respiratory changes after cholecystectomy peformed via laparotomy or laparoscopy[J].Br J Anesthesia,1992,69:341-345.
16.Thompson D,et al.The value of acute phase proteinmeasurements in clinical practice[J]. Ann Clin Binchemm,1992,29:123-131.
17.褚银平,邓勇志,杨喜钟.食管癌贲门癌患者血清C-反应蛋白监测的临床价值.山西临床医学,1997;6(2):70-73
18.雪林.SIRS和MODS防治新对策的实验研究-血必净的药效学观察[J].中国危重病急救医学,1997;9(12):720-722
19.张畔,曹书华,崔克亮.血必净对多脏器功能障碍综合征单核细胞HILA-DR表达影响的研究[J].中国中西医结合急救杂志,2002;9(1):21-23.
20.王今达.脓毒症一感染性MODS的预防[J].中国危重病急救医学,1999,11:453-455.
21.李志军,孙元莹,吴云良,等.血必净注射液防治家兔应激性脏器损伤的研究[J].中国危重病急救医学,2006,18:105-108.
22.王蔼卿,曹书华.血必净对感染性MODS治疗中细胞因子及预后影响.天津医药,2007;35(7):529.
23.Nelson KM,Vincent RG,Bourke RS,et al.Intraoperative intercostal nerve freezing to prevent postthoracotomy pain[J].Ann Thorac Surg.1974;18(3):280-285.
24.赵凤瑞,主译.Pearson FG,Clement A,Hiebert CA等.主编.普通胸部外科学[M].沈阳:辽宁教育出版社,1999.65.
25.Towu EA,Roethe RA,Weissig MD,et al.One-day admissionfor lung lobectomy:an incidental result of a clinical pathway[J].Ann Thorac Surg,1998,65(3):803-806
26.绍洋,张英民,梁良,等.术后不同镇痛方法对神经内分泌和细胞因子的影响[J].中华麻醉学杂志,2000,20:532-535.
27.郎保平.陈国生,张宇.开胸术后不同镇痛方法的疗效比较分析[J].中国综合临床,2003,19(6):540-541.
28.赵凤瑞,田燕雏,刘德若,等.肋间神经冷冻止痛的实验及临床研究[J].中华外科杂志,2001,39(11):852.85.
29.Zhou L,Shao Z,Ou S.Cryoanalgesia:electrophysiology at different temperatures Cryobiology,2003,46:26.
30.Evans PJ.Cryoanalgesia The application of low temperatures to nerves to produceanaesthesia oranalgesia[j].Anaesthesia,1981,36(11):1003-1013.
31.Moorjan N,Zhao FR,Tian YC et al.Effects of cryoanalgesia on postthoracotomy pain and on the structure Of intercostal nerve:a human prospective randomized trial and a histological study.Eur J Cadlothoracie Surg,2001,20:502.
32.Maiwand Mo,Makey R,Rees A,et al.Cryoanalgesia after thoracotomy.Improvement of technique and review of 600 cases[J].J Thorac CardiovasSury,1986,92(2):291-295.
33.Tovar EA.Minimally invasive approach for pneumonectomy culrninating in an outpatient procedure.Chest,1998,114(5):1454-1458.
34.米智慧.JT-I型冷冻手术治疗机在胸科手术中的应用[J].中华实用医学,2004,6(13):80.
35.王今达,雪林.细菌、内毒素、炎性介质并治-治疗重症脓毒症的新对策[J].中国危重病急救医学,1998,10(6):323-325.
36.王筠默.中药药理学[M].上海:上海科技出版社.1985:73.
37.尹钟珠.血小板功能分析在活血化瘀研究中的应用[J].实用中西医结合杂志,1991,4(7):440.
38.王拥军 何士大.抗氧化中药的研究现状[J].中国中西医结合杂志,1996.16(5):312.
1.Lloyd Jw,Bamard JD,Glynn CJ.Cryoanalgesia.A new approach to pain relief[J].Lancet,1976,2(7992):932-934.
2.Nelson KM,Vincent RG,Bourke RS,et al.Intraoperative intercostal nerve freezing to prevent postthoracotomy pain[J].Ann Thorac Surg.1974.18(3):280-285.
3.赵凤瑞,田燕雏,刘德若,等.肋间神经冷冻止痛的实验及临床研究[J].中华外科杂志,2001,39(11):852-854.
4.Callesen T,Bech K,Thorup J.et al Cryoanalgesia:efect on posthemiorrhaphypaln[J].Anesth Analg,1998,87(4):896-899.
5.Evans PJ.Cryoanalgesia The application of low temperatures to nerves to produceanaesthesia oranalgesia[j].Anaesthesia,1981,36(11):1003-1013.
6.Evans PJ,Lloyd JW,Jack TM.Cryoanalgesia for intractable perineal pain[J].J R Soc Med,1981,74(11):804-809.
7.Glynn CJ,Lloyd JW,Bamard J D.Cryoanalgesia in the management of pain after thoracotomy[J].Thorax,1980,35(5):325-327.
8.Riopelle JM.Everson CN.Moustoukas P.et al.Cryoanalgesia:Present day status[J].Seminars in Anesthesia,1985,4:305-312.
9.Maiwand Mo,Makey R,Rees A,et al.Cryoanalgesia after thoracotomy.Improvement of technique and review of 600 cases[J].J Thorac CardiovasSury,1986,92(2):291-295.
10.赵凤瑞,田燕雏,刘德若,等.肋间神经冷冻止痛的实验及临床研究[J].中华外科杂志,2001,39(11):852.85.
11.Tovar EA.Minimally invasive approach for pneumonectomy culrninating in an outpatient procedure.Chest,1998,114(5):1454-1458.
12.Cr G,Am D,Ap T,et al.Longterm follow-up of cryoanalgesia for chronic thoracic pain[J].Regional Anesthesia And Pain Medicine,1993.18:46.
13.Orr I A,Keenan DJ,Dundee JW.Improved pain relief,after thoracotomy:use of cryoprobe and morphine infusion[J].Br Med J(Clin Res Ed),1981,283(6297):945-948.
14.赵凤瑞,主译.Pearson FG,Clement A,Hiebert CA等.主编.普通胸部外科学[M].沈阳:辽宁教育出版社,1999.65.
15.Tiippana E,Nilsson E,Kalso E.Post-thoracotomy pain after thoracic epidural analgesia:a prospective follow-up study[J].Acta Anaesthesiol Scand,2003,47(4):433-438.