Objective To investigate the effects of hand assistant laporoscopic splenectomy plus pericardial devascularization on systemic stress responses. Methods Forty patients with cirrhotic portal hypertension were selected， 20 cases of which were underwent hand assistant laparoscopic splenectomy plus pericardial devascularization (LAP group)， and the other 20 were underwent open splenectomy plus pericardial devascularization (OP group). The levels of blood glucose （BG）, insulin (Ins), triiodothyronine （T3）, tetraiodothyronine （T4）, corticosteroid （CS） and other related clinical data were measured before operation and on day 1-3 after operation, which were compared between two groups. Results There was no statistical significance between two groups on those levels before operation. On day 1 after operation， BG and CS level in both two groups were higher than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (Pgt;0.05), and on day 3 after operation in OP group (Pgt;0.05). BG and CS level in OP group were markedly higher than those in LAP group on day 2 after operation (P＜0.05). On day 1 after operation， Ins, T3 and T4 level of two groups were lower than those before operation (P＜0.05), but they were recovered on day 2 after operation in LAP group (Pgt;0.05) and on day 3 after operation in OP group (Pgt;0.05). Ins, T3 and T4 level in OP group were lower than those in LAP group on day 2 after operation (P＜0.05). There was no significant difference in operation time between two groups (Pgt;0.05). But laparoscopic surgery had more advantages than conventional open surgery such as reducing bleeding quantity in operation, shortening recovery time of bowel and urinary bladder function and the length of stay. Conclusion Compared with laparotomy, the laparoscope not only imposes less impact on physical stress system, but also makes recovery after operation more quickly.
【Abstract】ObjectiveTo explore the mechanisms of anabolism intensified by recombination human growth hormone (GH) on the basis of total parenteral nutrition (TPN) during postoperative in gastrointestinal carcinoma patients. MethodsNinety-four gastrointestinal carcinoma patients undergone operation were randomly divided into TPN group and TPN+GH group. The levels of TNF-α, IL-1, IL-6 and CRP were detected in the first, third, seventh postoperative day. ResultsThe levels of TNF-α, IL-1, IL-6 and CRP were significantly lower in TPN+GH group than those in the TPN group at the first, third, seventh postoperative day （P＜0.01）. The levels of TNF-α, IL-1, IL-6 and CRP were significantly higher at the indicated time of postoperative days than the pre-operative days in the two groups (P＜0.01）. ConclusionBy inhibiting TNF-α, IL-1, IL-6 and CRP production in gastrointestinal carcinoma patients undergone operation and blocking high catabolism induced by inflammatory cytokines, GH promotes the synthesis of anabolism.
ObjectiveTo investigate the systemic stress responses after laparoscopic resection in colorectal cancer patients.MethodsSixty patients were randomized into the laparoscopic resection group (30 cases) and open resection group (30 cases) from October 2001 to September 2002 in our hospital.Analgesic dosages, recovery time of intestinal peristalsis, postoperative temperatures, C reactive protein(CRP), IL6 and white blood cell (WBC) counts were recorded after operation. ResultsThe changes of postoperative temperatures and WBC counts showed no significant difference between two groups.But in the laparoscopic resection group, the recovery time of intestinal peristalsis, postoperative analgesic dosages, CRP and IL6 significantly decreased (P＜0.01,P＜0.05).ConclusionCompared with traditional open resection, laparoscopic resection of colorectal cancer can diminish the systemic stress responses and decrease the injury to patients.
ObjectiveTo investigate whether parecoxib sodium preemptive analgesia reduces inflammatory cytokines and stress hormones production in elderly patients after total hip replacement. MethodSixty patients with American Society of Anesthesiologists Classification Ⅰ-Ⅱ undergoing total hip replacement for femoral neck fracture or aseptic necrosis of the femoral head, aged between 60 and 90 years with a body weight more than 50 kg, were randomly divided into preemptive analgesia group (group P, n=30) and control group (group C, n=30). The patients in group P received parecoxib sodium 40 mg intravenously 30 min before skin incision, and another 20 mg 8 hours after the first administration. All the patients in the two groups received the administration of patient-controlled analgesia sufentanyl. We recorded blood levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), cortisol (COR), adrenaline (AD) and noradrenaline (NAD) 30 min before skin incision, and 1 hour, 6 hours, 12 hours and 24 hours postoperatively. ResultsThe blood levels of IL-6, TNF-α, COR, AD and NAD in group P at 1 hour, 6 hours, 12 hours or 24 hours postoperatively were significantly lower than those in group C (P<0.05). ConclusionsParecoxib sodium preemptive analgesia reduces postoperative inflammatory cytokines and stress hormones production in elderly patients undergoing total hip replacement.
Objective To evaluate the influence of dexmedetomidine on the stress of elderly patients with cardiovascular risk undergoing gastrointestinal laparoscopic surgery. Methods From August 2014 to December 2015, 210 patients undergoing elective laparoscopic gastrointestinal operations were randomly divided into three groups, including the low concentration group (group D1), the high concentration group (group D2), and the control group (group C), with 70 cases in each group. The patients in group D1 and group D2 were injected with dexmedetomidine (0.4 and 0.8 μg/kg respectively) by infusion pump before anesthesia induction, and were continuously pumped with dexmedetomidine [0.4 and 0.8 μg/(kg·h) respectively] until the end of the surgery. Meanwhile, the patients in group C were injected with normal saline of the equal volumes. The heart rate and mean arterial pressure (MAP) was recorded before anesthesia, after endotracheal intubation and extubation. Myocardial ischemia and cardiovascular adverse events thatneeded to be handled were recorded. The concentrations of dopamine, adrenaline (AD) and noradrenaline (NE) were monitored at 15:00 one day before surgery (Ty), one hour after the beginning of surgery (T0), and at 15:00 of the 1st, 2nd, and 3rd day after surgery (T1, T2, T3). Results A total of 178 patients completed the study and were enrolled in this study, including 60 cases in group D1 and 59 cases in group D2 and C respectively. In group D1 and D2, the heart rates after intubation [(80.4±9.6), (68.2±10.5) times/minutes], extubation [(70.1±6.2), (69.7±7.8) times/minutes] and MAP after extubation [(100.2±12.0), (98.0±13.1) mm Hg (1 mm Hg=0.133 kPa)] were lower than those in group C [(98.4±10.5) and (95.2±7.3) times/minutes; (121.8±10.5) mm Hg], and the differences were significant (P<0.05). The bradycardia and hypotension in group D2 (27.12%, 22.03%) was significantly higher than those in group C (3.39%, 8.47%). Hypertension in group D1 and D2 (5.00%, 1.69%) was significantly lower than that in group C (37.29%), and the differences were significant (P<0.05). Compared with the base value at Ty in the three groups, the concentration of dopamine at T0-T3 in group C, at T0-T1 in group D1, and at T0 in group D2 increased significantly (P<0.05); the AD at T0-T3 in group C, at T0-T2 in group D1, and at T0-T1 in group D2 increased significantly (P<0.05); the NE at T0-T2 in group C, and at T1 in group D1 increased significantly (P<0.05). Compared with group C at the same time, the DA at T3 in group D1 and at T1-T3 in group D2, the AD at T2-T3 in group D1 and at T0-T3 in group D2, the NE at T0-T1 in group D1 and T0-T3 in group D2, decreased significantly (P<0.05). Conclusions Dexmedetomidine can effectively restrain the changes of hemodynamics and catecholamine induced by perioperative stress responses in a dose-dependent manner. During the surgery of elderly patients with cardiovascular risk, the concentration of dexmedetomidine should be controlled moderately to gain the optimal effect.