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鼻内镜下低温等离子切除术对扁桃体及腺样体肥大患儿创伤应激、CC类趋化因子的影响

Effect of nasal endoscopic-assisted low temperature plasma resection on traumatic stress and CC chemokines in children with tonsil and adenoidal hypertrophy

    摘要
  • 摘要:
    目的 探讨鼻内镜下低温等离子切除术对扁桃体及腺样体肥大患儿创伤应激、CC类趋化因子的影响。
    方法 前瞻性纳入120例扁桃体/腺样体肥大患儿，随机分为观察组与对照组，每组60例。观察组实施鼻内镜下低温等离子扁桃体/腺样体切除术，对照组实施常规扁桃体剥离术联合鼻内镜下腺样体吸切术。比较2组手术相关指标（手术时间、术中出血量、恢复正常饮食时间、白膜完全消退时间），视觉模拟评分法（VAS）评分；分析2组创伤应激指标降钙素原（PCT）、皮质醇（Cor）、前列腺素E2（PGE2）、前列腺素F2α（PGF2α），CC类趋化因子（CCL2、CCL21）及术后并发症总发生率。
    结果 观察组的手术时间、恢复正常饮食时间均短于对照组，术中出血量少于对照组，差异有统计学意义（P < 0.05）。术后1、3、5 d，观察组VAS疼痛评分均低于对照组，差异有统计学意义（P < 0.05）。术后1、3 d，观察组血清CCL2水平高于对照组，血清PCT、Cor、PGE2、PGF2α、CCL21水平均低于对照组，差异有统计学意（P < 0.05）。观察组术后并发症总发生率低于对照组，差异有统计学意（P < 0.05）。
    结论 鼻内镜下低温等离子切除术治疗扁桃体/腺样体肥大患儿创伤小，并发症少，能有效缓解术后疼痛，降低创伤应激反应及CC类趋化因子介导的免疫炎症反应程度。

     

    Abstract:
    Objective To investigate the effect of nasal endoscopic-assisted low temperature plasma resection on traumatic stress and CC chemokines in children with tonsil and adenoidal hypertrophy.
    Methods A total of 120 children with tonsil or adenoidal hypertrophy were prospectively enrolled. They were randomly divided into observation group and control group, with 60 cases in each group. The observation group was performed nasal endoscopic-assisted low temperature plasma tonsillectomy or adenoidectomy, while the control group was performed routine tonsillectomy combined with adenoidectomy under nasal endoscope. Surgery-related indicators (operative time, intraoperative blood loss, recovery to normal diet time and complete regression time of tunica albuginea), Visual Analogue Scale (VAS) score were compared between the two groups; traumatic stress indicatorsprocalcitonin (PCT), Cortisol(Cor), prostaglandin E2(PGE2) and prostaglandin F2α(PGF2α), CC chemokines(CCL2 and CCL21) and total incidence of postoperative complications were analyzed between the two groups.
    Results The operation time and normal diet time of the observation group were significantly shorter, and the intraoperative blood loss was significantly less than that of the control group (P < 0.05). At 1 day, 3, 5 days after operation, the VAS pain scores in the observation group were significantly lower than those in the control group (P < 0.05). At 1 day, 3 days after operation, the serum levels of CCL2 in observation group were significantly higher, the serum levels of PCT, Cor, PGE2, PGF2α and CCL21 in the observation group were significantly lower than those in the control group (P < 0.05). The total incidence of postoperative complications in the observation group was significantly lower than that in the control group (P < 0.05).
    Conclusion The nasal endoscopic-assisted low temperature plasma resection has less trauma and lower overall incidence of complications, which can effectively relieve postoperative pain and reduce the traumatic stress response and degree of CC chemokine mediated immune inflammatory response.

     

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