无气腹悬吊式腹腔镜和气腹腹腔镜手术对患者应激反应的影响比较  

Comparison of the Effect of Non-pneumoperitoneum Laparoscopic and Pneumoperitoneum Laparoscopic Surgery on Patients' Stress Response

作　　者：陈爱华 赵文英 CHEN Ai-hua;ZHAO Wen-ying(D epartm ent of O bsterics,Puchang H ospital of Pukou D istrict,Nanjing,Jiangsu Province,210031 China)

机构地区：[1]南京市浦口区浦厂医院妇产科,江苏南京210031

出　　处：《中外医疗》2017年第30期1-5,共5页China & Foreign Medical Treatment

摘　　要：目的探究无气腹悬吊式腹腔镜和气腹腹腔镜手术对患者应激反应的影响。方法方便选取2015年1月—2017年1月在该院妇科行择期腹腔镜子宫肌瘤切除术的患者90例,按随机数表法将其分为两组,每组45例。在全身静脉麻醉下,一组患者行无气腹悬吊式腹腔镜手术,即为无气腹组;另一组组患者行CO2气腹腹腔镜手术,即为气腹组。监测两组患者不同时间点应激反应指标的变化情况,并进行比较。结果在T0时点,两组患者的血糖、COR、NE、胰岛素、TNF-α、IL-6水平比较差异无统计学意义(P>0.05);但T1时间点后各指标水平均开始升高,气腹组血糖、COR、NE、TNF-α、IL-6水平在T2时间点达峰值,分别为(7.23±0.92)mmol/L、(630.51±97.78)pg/L、(467.18±31.72)pg/m L、(58.64±5.92)pg/L、(48.02±9.31)pg/L;胰岛素水平在T3时间点达峰值,为(14.42±0.72)m U/L;而无气腹组血糖、COR、NE、胰岛素、TNF-α、IL-6水平均于T3时达峰值,分别为(6.40±0.81)mmol/L、(537.40±112.37)pg/L、(407.65±21.81)pg/m L、(14.20±0.66)m U/L、(31.40±4.81)pg/L、(39.67±7.82)pg/L,不同时间点比较差异有统计学意义(P<0.05)。气腹组在T2时点的血糖水平高于无气腹组,在T1和T2时点的NE、胰岛素、TNF-α和IL-6水平高于无气腹组,在T1、T2和T3时间点的COR水平高于无气腹组,组间比较差异有统计学意义(P<0.05)。结论无气腹悬吊式腹腔镜手术有效避免了CO2气腹对机体的影响,使术中应激反应水平大大减轻,值得在临床上推广应用。Objective This paper tries to explore the effect of non-pneum operitoneum laparoscopic and pneum operitoneal laparoscopic surgery on the p atien t’s stress response.Methods 90 patients with laparoscopic myomectomy from January 2015 to January 2017 were convenient divided into two groups according to the random num ber m ethod,with 45 cases in each group.In the system ic anesthesia,a group of patients w ithout pneum operitoneum laparoscopic surgery,nam ed as nonpneum operitoneum group;the other group of patients with CO2 pneum operitoneum laparoscopic surgery,nam ed as the pneum operitoneum group.The changes of stress response indexes at different time points in two groups of patients were m onitored and com pared.Results At the time of T0,the levels of blood glucose,COR,NE,insulin,TN F-琢and IL-6 in the two groups were not statistically significant(P>0.05).But the indicators began to rise after the T1 tim e points,the levels of blood glucose,COR,NE,T N F-a and IL-6 in pneum operitoneum group reached the peak at T2 tim e of(7.23±0.92)mmol/L,(630.51±97.78)pg/L,(467.18±31.72)pg/m L,(58.64±5.92)pg/L,(48.02±9.31)pg/L;The insulin levels reached the peak at T3time point of(14.42±0.72)m U/L.However,the levels of blood glucose,COR,N E,insulin,T N F-a and IL-6 in n o n-p n eu m operitoneum group reached the peak at T3 tim e of(6.4 0±0.8 1)m m ol/L,(53 7.40±1 1 2.37)p g/L,(40 7.65±2 1.8 1)pg/m L,(14.20±0.66)m U/L,(31.40±4.81)pg/L,(39.67±7.82)pg/L respectively.The difference was statistically significant at different tim e points(P<0.05).The level of blood glucose in pneum operitoneum group was higher than non-pneum operitoneum group at T2;the levels of NE,insulin,TN F-琢and IL-6 in the pneum operitoneum group were higher than those in the n o n-p n eu m operitoneum group at T1 and T2,and the level of COR was higher than that of the group without pneum operitoneum;At T1,T2 and T3,the difference betw een the two groups was statistically significant in COR level(P<0.05).Conclusion Laparoscopic surgery w ithout

关 键 词：妇科手术 腹腔镜 CO2气腹 应激反应 

分 类 号：R713[医药卫生—妇产科学]