摘要
目的：探讨腹腔镜手术不同压力CO2气腹对患者机体的IL-1β，IL-6和TNF-α的影响。方法2010年10月～2012年6月择期腹腔镜手术90例，ASAⅠ或Ⅱ级，按病例时间分为10、12、15 mm Hg组。麻醉诱导成功后，3组分别以10、12和15 mm Hg气腹压力建立CO2气腹进行手术，分别于麻醉成功后（ T0）、气腹建立后（ T1）、摆放手术体位前（ T2）、手术完毕气腹消除后（T3）、术后24 h（T4）采集外周静脉血，测定白细胞介素1β（IL-1β），白细胞介素6（IL-6）和肿瘤坏死因子α（ TNF-α）水平，以及血流动力学指标并对测定结果进行统计学分析。结果组间比较：3组患者不同时点MAP、HR、PET CO2均无统计学差异（P＞0．05）；组内比较：3组患者不同时点 MAP、HR有显著差异（P＜0．05），PETCO2无统计学差异（P＞0.05）。组间比较：3组患者T1～T3时点IL-1β、IL-6、TNF-α均有统计学差异（ P＜0．05）；组内比较：3组IL-1β在T1、T2时点与T0比较差异有统计学意义（P＜0．05），10、12 mm Hg组不同时点IL-6无统计学差异（P＞0．05），15 mm Hg组在T1、T2、T3时点IL-6显著高于T0时点（P＜0．05），12、15 mm Hg组TNF-αT1、T2、T3时点与T0比较有统计学差异（P＜0．05），10 mm Hg组仅T0与T1时点有显著差异（ P＜0．05）。结论腹腔镜手术时气腹压力较小的应激反应较轻，以10 mm Hg为宜。
Objective To explore the effects of different pressures of carbon dioxide pneumoperitoneum under laparoscopic surgery on IL-1β, IL-6, and TNF-α. Methods Ninety patients with ASA Ⅰor Ⅱwho were scheduled to elective operation under laparoscopic surgery from October 2010 to June 2012 were randomly divided into three groups .After endotracheal intubation , different carbon dioxide pressures , 10 mm Hg, 12 mm Hg, and 15 mm Hg, were orderly given to group 1, 2, and 3 to build pneumoperitoneum .The serum levels of IL-1β, IL-6, and TNF-α, as well as hemodynamic parameters , were assessed at the time after anesthesia （ T0 ） , after pneumoperitoneum development （ T1 ） , of position placement before operation （ T2 ） , after dismissing pneumoperitoneum （T3）, and 24 hours after operation （T4）, respectively. Results The measures of MAP, HR, and PETCO2 had no significant differences between each other of the three groups （ P 〉0.05）, and the MAP and HR results showed significant differences among the three groups at different time points （P0.05）.There were statistical significances between the three groups in levels of IL-1β, IL-6, and TNF-αat time points of T1 , T2 , T3 , and T4 , respectively （P0.05）.In the group 3, the levels of IL-6 were significantly higher at time points of T 1, T2, and T3 than at T0（P〈0.05）.In the group 2 and group 3, the levels of TNF-αat T1, T2, and T3 were significantly different from at T0（P〈0.05）, whereas in the group 1, significant difference was seen only between the time points of T 0 and T1（P〈0.05）. Conclusion Low pneumoperitoneum pressure leads to minor stress effects .A 10 mm Hg carbon dioxide pneumoperitoneum is recommended .
出处
《中国微创外科杂志》
CSCD
2014年第11期1028-1032,1054,共6页
Chinese Journal of Minimally Invasive Surgery
基金
黄石市医药卫生立项科研项目
黄科技发农2013【1】号
关键词
腹腔镜手术
气腹压力
细胞因子
应激反应
Laparosopic surgery Pneumoperitoneum Cytokine Stress reaction
