悬吊式与气腹腹腔镜手术对机体应激反应的影响  

Effects of stress response in patients undergoing gynecological laparoscopic operation using carbon dioxide pneumoperitoneum or abdominal wall-lifting methods

作　　者：韩传宝[1] 钱燕宁[1] 刘华[1] 周钦海[1] 韩素萍[2] 

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏南京210029 [2]南京医科大学第一附属医院妇产科,江苏南京210029

出　　处：《中国实用妇科与产科杂志》2008年第4期282-284,共3页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：江苏省医学重点人才资助项目(RC2002058)

摘　　要：目的研究行悬吊式与气腹腹腔镜手术病人术中血皮质醇、白介素-6(IL-6)、白介素-10(IL-10)和肿瘤坏死因子-α(TNF-α)浓度的变化。方法选择2005年7月至2006年2月于南京医科大学第一附属医院择期行腹腔镜下卵巢肿瘤切除术的病人38例,随机分成两组,每组19例,手术时间均<100min。Ⅰ组,于静脉全麻下行CO2气体腹腔镜手术;Ⅱ组,于静脉全麻下行悬吊式腹腔镜手术。监测两组患者麻醉前(T1)、气腹或悬吊建立后30min(T2)、气腹或悬吊撤除后10min(T3)和术后次日晨8时(T4)4个时点的血皮质醇、IL-6、IL-10和TNF-α的浓度。结果麻醉前两组患者的血皮质醇、IL-6、IL-10和TNF-α差异无统计学意义(P>0.05)。术后各指标均升高,其中Ⅰ组在T3时达峰值,Ⅱ组在T4时达峰值。组间比较,Ⅰ组在T2时点的血皮质醇[(493.3±77.3)pg/L]和TNF-α[(31.4±13.7)pg/L]高于Ⅱ组[(422.9±75.6)pg/L,(24.2±9.8)pg/L](P<0.05);在T3时点,Ⅰ组的血皮质醇、TNF-α和IL-6均显著高于Ⅱ组,且Ⅰ组的IL-6/IL-10比值也高于Ⅱ组。结论悬吊式腹腔镜技术免除了CO2气腹对机体的影响,降低了术中应激反应水平。Objective To study the changes of serum cortisol,TNF-α,IL-6 and IL-10 in patients who underwent gynecological laparoscopic operations using carbon dioxide pneumoperitoneum or abdominal wall-lifting methods. Methods Thirty-eight patients scheduled for gynecological laparoscopy from July 2005 to February 2006, whose operation time was less than 100 min, were randomly divided into two groups（ Ⅰ , Ⅱ ）with 19 cases in each group respectively. Group Ⅰ patients were operated with the aid of CO2 insufflation under general anesthesia. Group Ⅱ patients were operated under general anesthesia and abdominal wall-lifting techniques. Monitoring for all patients included serum cortisol,TNF-α, IL-6 and IL-10 at four points ： before anesthesia（T1 ）, at 30min after the beginning of the operation（ T2 ） and 10min after the end of the surgery （ T3 ） and at 8 AM in the following day （ T4 ）. Results There were no obvious difference regarding the serum cortisol,TNF-α,IL-6 and IL-10 between the two groups at T1 （P 〉0. 05）, and these values increased after the beginning of the operations,which reached two their peak values in group Ⅰ at T3and in group Ⅱ at T4. The levels of serum cortisol and TNF-Ⅰ were higher in group Ⅰ than those in group Ⅱ at T2 （P 〈 0. 05 ）. At T3 point,levels of serum cortisol, TNF-α and IL-6 were significantly higher in group Ⅰ than those in group U （ P 〈 0. 01 ）, and was the same as the ratio of IL-6/IL-10（P 〈0. 05）. Conclusion Gynecological laparoscopic operation using abdominal wall-lifting methods can avoid the effect of CO2 pneumoperitoneum, and reduce the stress response during operation.

关 键 词：腹腔镜手术 CO2气腹 血皮质醇 白介素 肿瘤坏死因子 

分 类 号：R71[医药卫生—妇产科学]