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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 196 -199. doi: 10.3877/cma.j.issn.1674-3946.2022.02.021

论著

胆囊切除术中切断迷走神经肝支对患者左心功能及炎症反应的影响研究
李昊楠1,(), 王静1, 郑晶晶1, 沈江伦1, 丁梅1   
  1. 1. 063000 河北唐山,唐山市协和医院普外科
  • 收稿日期:2021-01-16 出版日期:2022-04-26
  • 通信作者: 李昊楠

Effect of hepatic branch of vagus nerve on left ventricular function and inflammatory response in cholecystectomy

Haonan Li1,(), Jing Wang1, Jingjing Zheng1, Jianglun Shen1, Mei Ding1   

  1. 1. Department of General Surgery, Tangshan Union Medical College Hospital, Tangshan Hebei Province 063000, China
  • Received:2021-01-16 Published:2022-04-26
  • Corresponding author: Haonan Li
  • Supported by:
    Hebei Provincial Health and Family Planning Commission Project(20181306); Hebei Provincial Science and Technology Plan Project(172767231)
引用本文:

李昊楠, 王静, 郑晶晶, 沈江伦, 丁梅. 胆囊切除术中切断迷走神经肝支对患者左心功能及炎症反应的影响研究[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(02): 196-199.

Haonan Li, Jing Wang, Jingjing Zheng, Jianglun Shen, Mei Ding. Effect of hepatic branch of vagus nerve on left ventricular function and inflammatory response in cholecystectomy[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(02): 196-199.

目的

探究胆囊切除术中切断迷走神经肝支对胆囊结石合并胆囊炎患者左心功能及炎症反应的影响。

方法

前瞻性选取2017年5月至2020年7月期间行胆囊切除术的234例胆囊结石合并胆囊炎患者作为研究对象。采用数字随机法分为两组,每组117例,其中传统组给予单纯腹腔镜胆囊切除术,改良组给予切断迷走神经肝支的腹腔镜胆囊切除术。数据采用SPSS 20.0统计软件完成,左心功能、炎症反应等计量资料用(

xˉ
±s)表示,采用独立样本t检验;胆心反射及胆心综合征发生率等计数资料采用χ2检验或Fisher检验。P<0.05差异有统计学意义。

结果

改良组患者胆心反射、胆心综合征发生率低于传统组(P<0.05)。气腹后30 min,两组患者左心功能每搏输出量(SV)、射血分数(EF)、心输出量(CO)及心率(HR)水平较术前降低,术后24 h逐渐恢复,改良组各指标变化幅度小于传统组(P<0.05)。术后3 d,改良组炎症因子血清TNF-α、IL-1β、IL-6及CRP水平低于传统组(P<0.05)。

结论

胆囊结石合并胆囊炎患者行胆囊切除术中切断迷走神经肝支能够预防胆心反射、胆心综合症的发生,保护患者左心功能,降低机体炎症反应水平。

Objective

To investigate the effect of hepatic branch of vagus nerve resection on left ventricular function and inflammatory response in patients with cholecystolithiasis complicated with cholecystitis.

Methods

234 patients with cholecystectomy and cholecystitis who underwent cholecystectomy from May 2017 to July 2020 were prospectively enrolled. 117 patients in each group were randomly divided into two groups. The control group was given simple laparoscopic cholecystectomy,and the observation group was given laparoscopic cholecystectomy with hepatic branch of vagus nerve cut off. SPSS20.0 statistical software was used to complete the data. Left heart function,inflammatory response and other measurement data were expressed as(

xˉ
±s),and independent sample t test was used. The χ2 test or Fisher's test were used for the statistical data of biliary cardioreflex and incidence of biliary cardiosyndrome. P<0.05 was statistically significant.

Results

The incidence of gallbladder-heart reflex and gallbladder-heart syndrome in observation group was lower than that in control group(P<0.05). 30 min after pneumoperitoneum,left cardiac function per stroke output(SV),ejection fraction(EF),cardiac output(CO)and heart rate(HR)levels in 2 groups were lower than those before surgery,and gradually recovered 24 h after surgery,and the change range of each index in observation group was less than that in control group(P<0.05). 3 days after operation,the levels of TNF-α,IL-1β,IL-6 and CRP in serum of inflammatory cytokines in observation group were lower than those in control group(P<0.05).

Conclusion

Cutting off the hepatic branch of the vagus nerve during cholecystectomy in patients with cholecystolithiasis complicated with cholecystitis can prevent the occurrence of cholecystolithiasis and cholecystolitis synthesis,protect the left ventricular function of patients,and reduce the level of inflammatory response.

表1 234例胆囊切除不同术式两组患者一般资料比较[(
xˉ
±s),例]
表2 234例胆囊结石合并胆囊炎患者不同术式两组胆心反射、胆心综合症发生情况[例(%)]
表3 234例胆囊结石合并胆囊炎患者不同术式两组患者左心功能变化比较(
xˉ
±s
表4 234例胆囊结石合并胆囊炎患者不同术式两组治疗前后炎症反应指标比较(
xˉ
±s
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