【作者】 杨正府；

【导师】 范然； 陈健；

【作者基本信息】 江苏大学 ， 外科学， 2009， 硕士

【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CO₂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CO₂气体模拟CO₂气腹,C组全麻模拟CO₂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CO₂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CO₂气腹有相关性,对指导临床治疗有一定的意义。更多还原

【Abstract】 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 CO₂ 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 CO₂ gas CO₂ pneumoperitoneum Analog,C group Analog CO₂ 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 CO₂ 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 CO₂ pneumoperitoneum has relevance in guiding clinical treatment must have meaning.更多还原