腹腔镜妇科手术对围术期创伤应激、酸碱平衡和能量代谢的影响  

Influence of Laparoscopic Gynecologic Surgery on Traumatic Stress Reaction,Acid-base Balance and Energy Metabolism during the Operation

作　　者：叶露[1] 王文凯[1] 陈慧琦[1] 付珊明 

机构地区：[1]广东省惠州市惠阳区妇幼保健院麻醉科,516000 [2]广东省惠州市中医院

出　　处：《医学理论与实践》2010年第6期637-639,共3页The Journal of Medical Theory and Practice

摘　　要：目的:研究腹腔镜妇科手术对围术期患者机体应激反应、酸碱平衡和能量代谢的影响。方法:筛选出择期妇科手术患者60例,随机分成2组,A组采用腹腔镜手术,B组采用开腹手术,于术前1d、术后1d和3d清晨分别检测血C-反应蛋白(CRP)、生长激素、皮质醇和胰岛素。同时测定静息能量消耗(REE)和呼吸商(RQ)。结果:胰岛素在B组患者术后第3天与术前比较有明显下降。生长激素、CRP和皮质醇上升在B组术后明显高于A组(P<0.05)。两组患者REE术后较术前显著增加,而术后B组患者REE明显高于A组(P<0.05)。两组患者RQ术后较术前均有显著下降。A组动脉血氧分压(PaO2)术后1d明显下降,第3天恢复。A组术后3d BE明显高于B组。结论:腹腔镜妇科手术创伤小于开腹手术,患者围术期应激水平低,对代谢影响小,有益于机体应激激素、机体内环境平衡的恢复。气腹可以引起体内酸血症和肺血灌流不足。Objective：To investigate the effect of laparoscopic gynecologic surgery on patients＇ stress reaction,acid-base balance and energy metabolism during the operation.Methods：60 elective gynecologic operation patients were classified randomly into two groups：Group A receiving laparoscopic surgery and Group B receiving open abdominal operation.The two groups were respectively detected serum C-reactive protein（CRP）,growth hormone,hydrocortisone and insulin in the morning of one day before the operation,one day and three days after the operation.Rest energy expenditure（REE）and respiratory quotient（RQ） were also checked.Results：In the Group B,insulin was significantly lower on the third day after operation than that of the day before operation.Growth hormone,CRP and hydrocortisone in Group B were higher than those in Group A（P0.05）after operation.In both groups,REE were not only increased compared with that before operation,but also REE in Group B was apparently higher than that in Group A（P0.05）.All cases had a significant decrease in RQ after operation.In Group A,arterial blood partial pressure of oxygen（PaO2）had a obvious decline at the first day after operation,which would recover on the third day.BE in Group A was higher than that in Group B at the third day after operation.Conclusion：Laparoscopic gynecologic surgery is less invasive compared to open surgical resection;lower perioperative stress reaction;minor influence of energy metabolism;and it is good for the recovery of stress hormone and the balance of body internal environment.Pneumoperitoneum can bring to ketoacidosis and the shortage of lung perfusion.

关 键 词：妇科手术 腹腔镜 应激反应 酸碱平衡 能量代谢 

分 类 号：R713[医药卫生—妇产科学]