椎间盘镜腰椎间盘切除术与开放式手术对患者应激反应的实验研究.DOCVIP

临床医学论文-椎间盘镜腰椎间盘切除术与开放式手术对患者应激反应的实验研究 ??????????????作者：王晖，吴小涛，熊传芝，马超，陈明 【摘要】? ［目的］研究椎间盘镜腰椎间盘切除术与开放式手术对患者细胞因子应激反应的影响。［方法］前瞻性随机对照研究：选择符合研究条件的病人，随机分为两组。一组采用椎间盘镜（METRx）行后路腰椎间盘髓核摘除术，另一组行开放式腰椎间盘髓核摘除术，各约30例。采用酶联免疫吸附试验（ELISA）法分别检测手术前和手术后第1、2、4、8、24、48 h患者血清中白细胞介素1β（IL1β）、白细胞介素6（IL6）、肿瘤坏死因子α（TNFα）的数值。同时检测各时段血清C反应蛋白（CRP）和外周血白细胞（WBC）数量。［结果］采用椎间盘镜髓核摘除术（MED）组相比开放式手术（OD）组手术切口小、出血少、住院时间短，但手术时间偏长。两组手术前后比较肢体疼痛视觉模拟评分（VAS）值均明显降低。术后24 h两组CRP值均达到峰值，但OD组较MED组（CRP）值明显升高。术后8 h左右IL1β、IL6、TNFα均达到峰值，OD组较MED组IL1β、IL6、TNFα值均明显升高。术后24 h WBC数量OD组较MED组明显升高。［结论］椎间盘镜（METRx）腰椎间盘切除术与开放式手术相比，患者组织细胞因子应激反应小，创伤小，疗效接近。 【关键词】? 应激反应； 椎间盘切除术； 细胞因子；椎间盘镜（METRx） ??????? Abstract：［Objective］Systemic cytokines are recognized as markers of postoperative tissue trauma.This study investigates the effects of systemic cytokines after microendoscopic discectomy（MED）and open discectomy（OD）using SC as markers of postoperative tissue injury.［Method］Sixty patients who had symptomatic lumbar disc herniations were prospectively randomized to undergo either MED（n= 29）or OD（n= 31）.Serum levels of tumor necrosis factorα（TNFα）,Interleukin1β（IL1β）,and Interleukin6（IL6）were measured before surgery and at 1,2,4,8,24 and 48 h after surgery using an enzymelinked immunosorbent assay（ELISA）.Serum Creactive protein（CRP）and white blood cells（WBC）were measured at the same time interval.［Result］The results showed the MED patients had shorter postoperative hospital stay and less intraoperative blood loss.The mean size of skin incision and paraspinal muscle damage made for the MED patients was less than that of the OD patients.The operating time,including the setup time,was longer in the MED group.The patients pain severity of the involved limbs on 10point Visual Analog Scale（VAS）before operation step down in both groups after operarzon,CRP levels peaked at 24 h in both groups,and OD patients alsplaved a significantly greater postoperative rise in serum CRP.In the MED group,IL1β,IL6,TNFα level peaked of 8 h after sur