丙烯腈模拟电刀尾气及CO_2气腹与腹腔镜术后呕吐的相关性研究
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摘要
手术后恶心、呕吐(Postoperative Nausea and Vomiting PONV)是围手术期最值得关注的问题之一,是我们临床医生必须面对的一个看似小的其实是很重要的问题,微创外科是外科领域的一次技术性革命,尤其是腹腔镜具有创伤小、痛苦小、失血少、恢复快等微创特点,但是随之而来的PONV的高发病率日益突出,PONV高发生率的原因是近年来临床研究的课题之一。
目的:
通过酶联免疫吸附测定(定量)来检测应用丙烯腈模拟电刀尾气及模拟腹腔镜手术后实验动物-健康家养猫血液和脑脊液内的5-羟色胺、多巴胺的含量,探讨应用丙烯腈模拟电刀尾气及CO_2气腹对模拟腹腔镜术后动物呕吐的影响。
方法:
选择普通健康家养猫,观察无疾病等并发症后,随机分成四组,每组均采用氯胺酮加苯巴比妥钠(鲁米那)全麻,对照组A组仅单纯全麻,B组全麻后腹腔内注入CO_2气体模拟CO_2气腹,C组全麻模拟CO_2气腹后腹腔内注射丙烯腈模拟腹腔镜手术后状态,D组全麻后腹腔内注射丙烯腈,然后观察实验动物的呕吐发生情况并分别检测实验动物的血液和脑脊液内的5-羟色胺、多巴胺的含量,进行统计学分析,比较各组血液和脑脊液内的5-羟色胺、多巴胺的含量的差异。
结果:
1、术后呕吐情况:各组实验动物(健康家养猫)实验后均呼吸平稳,生命体征平稳,A组有5只呕吐,B组有8只呕吐,C组有13只呕吐,D组有11只呕吐,无一例死亡,各组呕吐率分别为33.3%、53.3%、86.7%、73.3%。A、B两组呕吐情况相比较,有差异性(P＜0.05);A、C两组及B、C各两组呕吐情况相比较,均差异具有显著性(P＜0.0 1);A、D两组及B、D各两组呕吐情况相比较,有筹异性(P＜0.05);C、D两组比较无均差异(P＞0.05)。
2、通过统计分析血液和脑脊液内的5-羟色胺及多巴胺含量结果:A组和B组相比较有差异性(P＜0.05);A组和C组相比较差异具有显著性(P＜0.0 1);A组与D组相比较差异具有显著性(P＜0.01);B组与C组相比较差异有显著性(P＜0.05);B组与D组相比较差异有显著性(P＜0.05);C组和D组相比较差异不明显(P＞0.05)。
结论:
根据所进行实验的结果得出结论:模拟腹腔镜术后动物的呕吐情况与应用模拟丙烯腈电刀尾气及CO_2气腹所引起血液和脑脊液内的5-羟色胺、多巴胺含量的变化有一定的相关性,由此可以推测腹腔镜术后的恶心、呕吐与电刀尾气及CO_2气腹有相关性,对指导临床治疗有一定的意义。
Post-operative nausea and vomiting(PONV) during perioperative period are the most noteworthy problem is one of our clinicians have to face a small problem,the field of minimally invasive surgery is a surgical technical revolution,especially with the laparoscopic trauma and pain of small,less blood loss,quick restore features,such as minimally invasive, but the resulting high incidence of PONV increasingly prominent,PONV the reasons for the high incidence of clinical research in recent years are one of the topics.
Objective:
Through enzyme-linked immunosorbent assay(quantitative) to detect the application of electric knife Analog AN Analog exhaust and after laparoscopic surgery of laboratory animals - cats healthy home with blood and cerebrospinal fluid 5-serotonin,dopamine levels to explore the application of acrylonitrile Analog electric knife exhaust gas and CO_2 pneumoperitoneum on laparoscopic simulation of the impact of postoperative vomiting animals.
Methods:
Choose an ordinary house cat health observed no complications after the disease were randomly divided into four groups,each using ketamine add sodium phenobarbital(Luminal ) anesthesia,the control group A group of only general anesthesia alone,B group-wide Ma after the intraperitoneal injection of CO_2 gas CO_2 pneumoperitoneum Analog,C group Analog CO_2 anesthesia after pneumoperitoneum analog intraperitoneal injection of acrylonitrile status after laparoscopic surgery, D group after anesthesia intraperitoneal injection of acrylonitrile,and then observation of experimental animals vomiting and were used to detect the occurrence of experimental animals within the blood and cerebrospinal fluid 5-serotonin,dopamine levels were statistically analyzed to compare blood and cerebrospinal fluid in each group of 5-serotonin, dopamine content differences.
Results:
1,After vomiting cases:laboratory animals in each group(Healthy family cat) to breathe after the experiment were stable,vital signs stable, Five of A group there is vomiting,B group has eight vomiting,C group 13 have vomiting,D group 11 vomiting,no case of death,the rate of vomiting in each group were 33.3%,53.3%,86.7%,73.3%.A,B and vomiting were compared to the situation there is different(P <0.05);A,C groups and the B,C vomiting all groups compared to the situation,the differences were significant(P <0.01);A,D the two groups and the B,D of the two groups of vomiting compared to the situation there is different (P <0.05);C,D are no differences between the two groups(P > 0.05).
2,Through statistical analysis of blood and cerebrospinal fluid 5-serotonin and dopamine content of the results:A group and B group compared to have differences(P <0.05);A and C compared to group difference was significant(P <0.01);A group compared with the D group difference was significant(P <0.01);B group and C group compared to the difference was significant(P <0.05);B group compared with the D group there were significant differences(P <0.05 );C group and D group compared with no obvious difference(P > 0.05).
Conclusion:
According to the results of the experiment concluded:Analog animals vomiting after laparoscopic cases and application of electric knife Analog acrylonitrile exhaust and CO_2 pneumoperitoneum caused by the blood and cerebrospinal fluid 5-serotonin,dopamine content must have the relevant nature,it can be speculated laparoscopic surgery nausea, vomiting and tail gas and electric knife CO_2 pneumoperitoneum has relevance in guiding clinical treatment must have meaning.
目的:
通过酶联免疫吸附测定(定量)来检测应用丙烯腈模拟电刀尾气及模拟腹腔镜手术后实验动物-健康家养猫血液和脑脊液内的5-羟色胺、多巴胺的含量,探讨应用丙烯腈模拟电刀尾气及CO_2气腹对模拟腹腔镜术后动物呕吐的影响。
方法:
选择普通健康家养猫,观察无疾病等并发症后,随机分成四组,每组均采用氯胺酮加苯巴比妥钠(鲁米那)全麻,对照组A组仅单纯全麻,B组全麻后腹腔内注入CO_2气体模拟CO_2气腹,C组全麻模拟CO_2气腹后腹腔内注射丙烯腈模拟腹腔镜手术后状态,D组全麻后腹腔内注射丙烯腈,然后观察实验动物的呕吐发生情况并分别检测实验动物的血液和脑脊液内的5-羟色胺、多巴胺的含量,进行统计学分析,比较各组血液和脑脊液内的5-羟色胺、多巴胺的含量的差异。
结果:
1、术后呕吐情况:各组实验动物(健康家养猫)实验后均呼吸平稳,生命体征平稳,A组有5只呕吐,B组有8只呕吐,C组有13只呕吐,D组有11只呕吐,无一例死亡,各组呕吐率分别为33.3%、53.3%、86.7%、73.3%。A、B两组呕吐情况相比较,有差异性(P＜0.05);A、C两组及B、C各两组呕吐情况相比较,均差异具有显著性(P＜0.0 1);A、D两组及B、D各两组呕吐情况相比较,有筹异性(P＜0.05);C、D两组比较无均差异(P＞0.05)。
2、通过统计分析血液和脑脊液内的5-羟色胺及多巴胺含量结果:A组和B组相比较有差异性(P＜0.05);A组和C组相比较差异具有显著性(P＜0.0 1);A组与D组相比较差异具有显著性(P＜0.01);B组与C组相比较差异有显著性(P＜0.05);B组与D组相比较差异有显著性(P＜0.05);C组和D组相比较差异不明显(P＞0.05)。
结论:
根据所进行实验的结果得出结论:模拟腹腔镜术后动物的呕吐情况与应用模拟丙烯腈电刀尾气及CO_2气腹所引起血液和脑脊液内的5-羟色胺、多巴胺含量的变化有一定的相关性,由此可以推测腹腔镜术后的恶心、呕吐与电刀尾气及CO_2气腹有相关性,对指导临床治疗有一定的意义。
Post-operative nausea and vomiting(PONV) during perioperative period are the most noteworthy problem is one of our clinicians have to face a small problem,the field of minimally invasive surgery is a surgical technical revolution,especially with the laparoscopic trauma and pain of small,less blood loss,quick restore features,such as minimally invasive, but the resulting high incidence of PONV increasingly prominent,PONV the reasons for the high incidence of clinical research in recent years are one of the topics.
Objective:
Through enzyme-linked immunosorbent assay(quantitative) to detect the application of electric knife Analog AN Analog exhaust and after laparoscopic surgery of laboratory animals - cats healthy home with blood and cerebrospinal fluid 5-serotonin,dopamine levels to explore the application of acrylonitrile Analog electric knife exhaust gas and CO_2 pneumoperitoneum on laparoscopic simulation of the impact of postoperative vomiting animals.
Methods:
Choose an ordinary house cat health observed no complications after the disease were randomly divided into four groups,each using ketamine add sodium phenobarbital(Luminal ) anesthesia,the control group A group of only general anesthesia alone,B group-wide Ma after the intraperitoneal injection of CO_2 gas CO_2 pneumoperitoneum Analog,C group Analog CO_2 anesthesia after pneumoperitoneum analog intraperitoneal injection of acrylonitrile status after laparoscopic surgery, D group after anesthesia intraperitoneal injection of acrylonitrile,and then observation of experimental animals vomiting and were used to detect the occurrence of experimental animals within the blood and cerebrospinal fluid 5-serotonin,dopamine levels were statistically analyzed to compare blood and cerebrospinal fluid in each group of 5-serotonin, dopamine content differences.
Results:
1,After vomiting cases:laboratory animals in each group(Healthy family cat) to breathe after the experiment were stable,vital signs stable, Five of A group there is vomiting,B group has eight vomiting,C group 13 have vomiting,D group 11 vomiting,no case of death,the rate of vomiting in each group were 33.3%,53.3%,86.7%,73.3%.A,B and vomiting were compared to the situation there is different(P <0.05);A,C groups and the B,C vomiting all groups compared to the situation,the differences were significant(P <0.01);A,D the two groups and the B,D of the two groups of vomiting compared to the situation there is different (P <0.05);C,D are no differences between the two groups(P > 0.05).
2,Through statistical analysis of blood and cerebrospinal fluid 5-serotonin and dopamine content of the results:A group and B group compared to have differences(P <0.05);A and C compared to group difference was significant(P <0.01);A group compared with the D group difference was significant(P <0.01);B group and C group compared to the difference was significant(P <0.05);B group compared with the D group there were significant differences(P <0.05 );C group and D group compared with no obvious difference(P > 0.05).
Conclusion:
According to the results of the experiment concluded:Analog animals vomiting after laparoscopic cases and application of electric knife Analog acrylonitrile exhaust and CO_2 pneumoperitoneum caused by the blood and cerebrospinal fluid 5-serotonin,dopamine content must have the relevant nature,it can be speculated laparoscopic surgery nausea, vomiting and tail gas and electric knife CO_2 pneumoperitoneum has relevance in guiding clinical treatment must have meaning.
引文
[1].Kovac AL.Prevention and treatment of postoperative nausea a nd vomiting.Dmgs.2000 Feb;59(2) 213-43.
[2].FujⅡy,Tanakah,Toyookah.Prevention of nausea and vomiting in female patients undergoing beast surgery[J].Acta Aneaesthesiol Scand,1998,42:220.
[3].Xavier C,Jean BC,Giovanni G,et al.The antiem etic efficacy of droperidol added to morphine patient-controlled analgesia;a randomized,controlled,multicenter dose-finding study.Anesth Analg,2003;97:816.
[4].Yuksek MS,Alici HA,Erdem AF,et al.Comparison of prophylactic anti-emetic effects of ondansetron and dexamethasone in women undergoing day-case gynaecological laparoscopic surgery.J Int Med Res.2003 Nov-Dec;31(6):481-8.
[5].M.Tramer,A.Moore and H.McQuay.Propofol anaesthesia and postoperative nausea and vomiting:quantitative systematic review of randomized controlled studies.British Journal of Anaesthesia,1997,78:247-255.
[6].Nursal TZ,Yildirim S,Tarim A,et al.Effect of dyaimage on postoperative nausea,vomiting,and pain after laparoscopic cholecystectomy.Langenbecks Arch Sury,2003,388(2):95-100.
[7].轩诗进,胡三元,陈波,等.腹腔镜胆囊切除术后恶心呕吐相关多因素分析的研究.中国医师杂志,2007,6(9):791-792.
[8].黄文海,朱江帆.外科手术中产生的烟气:仅仅是大量的热空气吗?.中国微创外科杂志,2005,4(5):263-265.
[9]陆荣柱,陈自强,金复生.丙烯腈对大鼠脑单胺类神经递质及其代谢产物的影响.中华预防医学杂志,2005,3(39):122-125.
[10].佟冬青,刘文生,路艳蕊,等.接触低浓度丙烯腈的工作人员健康水平的调查.中国民康医学杂志,2004,12(16):763-764.
[11].高萱,孙立孔,孔哲,等.恶心呕吐及其神经化学机制的研究.医学综述,2007,7(13):1043-1045.
[12].陈金宝.腹腔镜胆囊切除术CO_2气腹压对病人术后恶心呕吐发生的影响.安徽医学,2006,4(27):293-294.
[13].Minami M,Endo T,Hamau N,et al.Serotonin and anticancer drug-induced emesis[J].Yakugaku Zasshi,2004,124(8):491-507.
1Kovac AL.Prevention and treatment of postoperative nausea and vomiting.Drugs.2000Feb;59(2) 213-43.
2冷大跃,谭兴国,熊斐.调和升降法防治腹腔镜术后肩痛呕吐的临床观察.中国临床医生,2003,31(8):62
3吴志棉,关朝旭,赵献振,等.腹腔镜术后的原因和预防.中国内镜杂志,1997,3(4):11
4Yuksek MS,Alici HA,Erdem AF,Cesur M.Comparison of prophylactic anti-emetic effects of ondansetron and dexamethasone in women undergoing day-case gynaecological laparoscopic surgery.J Int Med Res.2003 Nov-Dec;31(6):481-8.
5Liwack K,Parnass S.Practical points in the management of postoperative nausea and vomiting[J].J Post Anaesth Nur,1998,3:275.
6Makineh MT,Yli - Hankala A.The effect of laparoscop ic cholecystectomy on resp iratory comp liance as determined bycontinuous sp irometry.J Clin Anesth,1996,8(2):119 - 122.
7张景华.LC人工气腹的常见并发症及其预防.腹腔镜外科杂志,2002,4(7):251.
8龚昭,周程等.腹腔镜术后并发呕吐相关因素分析.中国内镜杂志,2006,4(12):365.
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[2].FujⅡy,Tanakah,Toyookah.Prevention of nausea and vomiting in female patients undergoing beast surgery[J].Acta Aneaesthesiol Scand,1998,42:220.
[3].Xavier C,Jean BC,Giovanni G,et al.The antiem etic efficacy of droperidol added to morphine patient-controlled analgesia;a randomized,controlled,multicenter dose-finding study.Anesth Analg,2003;97:816.
[4].Yuksek MS,Alici HA,Erdem AF,et al.Comparison of prophylactic anti-emetic effects of ondansetron and dexamethasone in women undergoing day-case gynaecological laparoscopic surgery.J Int Med Res.2003 Nov-Dec;31(6):481-8.
[5].M.Tramer,A.Moore and H.McQuay.Propofol anaesthesia and postoperative nausea and vomiting:quantitative systematic review of randomized controlled studies.British Journal of Anaesthesia,1997,78:247-255.
[6].Nursal TZ,Yildirim S,Tarim A,et al.Effect of dyaimage on postoperative nausea,vomiting,and pain after laparoscopic cholecystectomy.Langenbecks Arch Sury,2003,388(2):95-100.
[7].轩诗进,胡三元,陈波,等.腹腔镜胆囊切除术后恶心呕吐相关多因素分析的研究.中国医师杂志,2007,6(9):791-792.
[8].黄文海,朱江帆.外科手术中产生的烟气:仅仅是大量的热空气吗?.中国微创外科杂志,2005,4(5):263-265.
[9]陆荣柱,陈自强,金复生.丙烯腈对大鼠脑单胺类神经递质及其代谢产物的影响.中华预防医学杂志,2005,3(39):122-125.
[10].佟冬青,刘文生,路艳蕊,等.接触低浓度丙烯腈的工作人员健康水平的调查.中国民康医学杂志,2004,12(16):763-764.
[11].高萱,孙立孔,孔哲,等.恶心呕吐及其神经化学机制的研究.医学综述,2007,7(13):1043-1045.
[12].陈金宝.腹腔镜胆囊切除术CO_2气腹压对病人术后恶心呕吐发生的影响.安徽医学,2006,4(27):293-294.
[13].Minami M,Endo T,Hamau N,et al.Serotonin and anticancer drug-induced emesis[J].Yakugaku Zasshi,2004,124(8):491-507.
1Kovac AL.Prevention and treatment of postoperative nausea and vomiting.Drugs.2000Feb;59(2) 213-43.
2冷大跃,谭兴国,熊斐.调和升降法防治腹腔镜术后肩痛呕吐的临床观察.中国临床医生,2003,31(8):62
3吴志棉,关朝旭,赵献振,等.腹腔镜术后的原因和预防.中国内镜杂志,1997,3(4):11
4Yuksek MS,Alici HA,Erdem AF,Cesur M.Comparison of prophylactic anti-emetic effects of ondansetron and dexamethasone in women undergoing day-case gynaecological laparoscopic surgery.J Int Med Res.2003 Nov-Dec;31(6):481-8.
5Liwack K,Parnass S.Practical points in the management of postoperative nausea and vomiting[J].J Post Anaesth Nur,1998,3:275.
6Makineh MT,Yli - Hankala A.The effect of laparoscop ic cholecystectomy on resp iratory comp liance as determined bycontinuous sp irometry.J Clin Anesth,1996,8(2):119 - 122.
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