腹腔镜微创术CO_(2)气腹对阑尾炎腹内感染患儿细胞免疫因子和肠道功能的影响  

Effects of CO_(2) pneumoperitoneum on cellular immune factors and intestinal function in children patients with appendicitis complicated with intra-abdominal infection during laparoscopic minimally invasive surgery

作　　者：马志 王慧智 李术平 于清娜 芦德智 MA Zhi;WANG Hui-zhi;LI Shu-ping;YU Qing-na;LU De-zhi(Hongqi Hospital Affiliated to Heilongjiang Mudanjiang Medical University,Mudanjiang,Heilongjiang157001,China)

机构地区：[1]黑龙江省牡丹江医学院附属红旗医院小儿外科,黑龙江牡丹江157001

出　　处：《中华医院感染学杂志》2021年第8期1211-1215,共5页Chinese Journal of Nosocomiology

基　　金：“红旗科研基金”科技项目(2018HQ-28)。

摘　　要：目的探讨腹腔镜微创术中不同压力二氧化碳(CO2)气腹对阑尾炎腹内感染患儿细胞免疫因子和肠道功能的影响。方法选择2018年1月-2020年1月间黑龙江省牡丹江医学院附属红旗医院收治的200例急性化脓性阑尾炎患儿作为研究对象,患儿均行腹腔镜阑尾切除术(LA),按治疗方式不同分为低气腹压组(n=100)和对照组(n=100),对照组气腹压10~12 mmHg,低气腹压组气腹压8~10 mmHg。比较两组术野清晰度;气腹前、气腹15 min、气腹30 min,评估两组生命体征[心率(HR)、平均动脉压(MAP)、二氧化碳分压(PaCO2)],比较两组气腹前、术后1h、术后24h细胞免疫及炎性因子[T细胞亚群、白介素-6(IL-6)、C反应蛋白(CRP)]、胃肠功能(首次排气时间、进食时间、排便时间)。结果两组术野清晰度总优良率对比,差异无统计学意义;气腹前、气腹15 min及30 min,两组HR对比差异均无统计学意义,两组MAP、PaCO2均呈上升趋势(P<0.05),气腹15 min及30 min低气腹压组MAP、PaCO2均小于对照组(P<0.05),不同时间点不同气腹压与MAP、PaCO2存在交互作用(P<0.05);气腹前、术后1 h及24 h时,两组CD3+、CD4+/CD8+对比差异均无统计学意义;两组IL-6、CRP均持续上升趋势(P<0.05),低气腹压组术后1h时IL-6、CRP低于对照组(P<0.05),不同时间点不同气腹压与IL-6、CRP存在交互作用(P<0.05);低气腹压组首次排气时间、进食时间、排便时间均短于对照组(P<0.05)。结论在LA患儿术中应用低气腹压,有利于改善患儿生命体征和早期炎性反应,也能保护其胃肠道功能。OBJECTIVE To investigate the effects of different carbon dioxide(CO2) pneumoperitoneum pressures on cellular immune factors and intestinal function in children patients with appendicitis complicated with intra-abdominal infection during laparoscopic minimally invasive surgery. METHODS A total of 200 children patients with acute suppurative appendicitis admitted to Hongqi Hospital Affiliated to Heilongjiang Mudanjiang Medical University between Jan 2018 and Jan 2020 were included as the research subjects. They were divided into the low pneumoperitoneum pressure group(n=100) and control group(n=100) according to different treatment methods. The two groups were given laparoscopic appendectomy(LA): the control group was given pneumoperitoneum pressure of 10-12 mmHg, and the low pneumoperitoneum pressure group was given pneumoperitoneum pressure of 8-10 mmHg. The surgical field clarity was compared between the two groups. Before pneumoperitoneum, 15 min after pneumoperitoneum and 30 min after pneumoperitoneum, the vital signs including heart rate(HR), mean arterial pressure(MAP) and partial pressure of carbon dioxide(PaCO2) were compared between the two groups. The cellular immune factors and inflammatory factors, including T cell subsets, interleukin-6(IL-6) and C-reactive protein(CRP), and gastrointestinal function indexes such as first exhaust time, eating time and defecation time were compared between the two groups before pneumoperitoneum, 1 h after surgery and 24 h after surgery. RESULTS There was no significant differences in the overall excellent and good rate of surgical field clarity between the two groups. There was no significant difference in HR between the two groups before pneumoperitoneum and 15 min and 30 min after pneumoperitoneum;and the MAP and PaCO2 between the two groups showed an upward trend(P<0.05). The MAP and PaCO2 in low pneumoperitoneum pressure group were significantly lower than those in control group 15 min and 30 min after pneumoperitoneum(P<0.05). There were interaction effects betwee

关 键 词：急性化脓性阑尾炎 腹腔镜手术 CO_(2)气腹压力 免疫功能 胃肠道功能 

分 类 号：R574.61[医药卫生—消化系统]