不同CO_(2)气腹压对腹腔镜上消化道穿孔修补术后炎性反应的影响  

Effects of different CO_(2) pneumoperitoneal pressure on inflammatory response after laparoscopic upper gastrointestinal perforation repair

作　　者：章琪[1] 徐爱忠[1] 汪东树[1] 王永胜[1] Zhang Qi;Xu Aizhong;Wang Dongshu;Wang Yongsheng(Department of General Surgery,Anqing Hospital Affiliated to Anhui Medical University,Anqing 246003,China)

机构地区：[1]安徽医科大学附属安庆医院普外科,安庆246003

出　　处：《中华普通外科学文献（电子版）》2022年第4期278-282,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：安庆市科技局科技计划资助项目(2020Z4007)。

摘　　要：目的探讨不同CO_(2)气腹压下腹腔镜上消化道穿孔手术患者术后恢复情况,以及不同气腹压对炎性反应和感染吸收的影响。方法按照前瞻性研究原则,采取便利抽样法选择2019年6月至2021年6月安徽医科大学附属安庆医院收治的上消化道溃疡穿孔患者50例,按照随机数字表法分为观察组24例(气腹压8~12 mmHg,即1.064~1.596 kPa)和对照组26例(气腹压13~15 mmHg,即1.729~1.995 kPa),两组均行腹腔镜探查+溃疡穿孔修补术,对比两组患者围手术期指标,术后恢复过程、并发症发生情况以及术前1 h和术后第1、4天炎性指标白细胞计数(WBC)、C反应蛋白(CRP)及降钙素原(PCT)变化。结果患者均顺利完成手术,两组手术时间差异无统计学意义,观察组术后肛门恢复排气时间、住院时间、住院总费用均少于对照组(t=-3.006、-2.514、-7.012,均P<0.05);两组术后并发症发生率比较,差异无统计学意义(χ^(2)=2.427,P=0.119);两组术前1 h炎性指标差异无统计学意义,而术后第1、4天比较,对照组的WBC、CRP及PCT显著高于观察组(均P<0.05)。结论将气腹压控制在8~12 mmHg,既不影响腹腔镜上消化道穿孔修补手术的完成,又能减少机体对感染毒素的吸收,同时对患者胃肠功能恢复有积极作用,是较为理想的选择。Objective To investigate the postoperative recovery of patients undergoing laparoscopic upper gastrointestinal perforation repair under different pneumoperitoneum pressures.Methods According to the principle of prospective study,50 patients with upper gastrointestinal perforation who were admitted to Anqing Hospital Affiliated to Anhui Medical University from June 2019 to June 2021 were selected and randomly divided into two groups:the observation group(24 cases,pneumoperitoneal pressure 8-12 mmHg,i.e.1.064-1.596 kPa)and the control group(26 cases,pneumoperitoneum pressure 13-15mmHg,i.e.1.729-1.996 kPa).The patients in the two groups underwent laparoscopic exploration+ulcer perforation repair.The postoperative recovery process,complications,and the changes of inflammatory indexes(leukocyte count,C-reactive protein and procalcitonin)at one hour before operation and on the first and fourth day after operation were compared between the two groups.Results Both groups successfully completed the operation,and there was no significant difference in operation time between the two groups.The postoperative anal recovery time,length of hospital stay,and total hospitalization expenses in the observation group were less than those in the control group(t=-3.006,-2.514,-7.012;all P<0.05);the incidence of postoperative complications in the observation group was lower than that in the control group,but the difference was not statistically significant(χ^(2)=2.427,P=0.119).There were no significant differences in inflammatory indexes between the two groups one hour before operation,but the indexes in the control group was significantly higher than those in the observation group on the first and fourth day after operation(all P<0.05).Conclusion During laparoscopic repair of upper gastrointestinal perforation,controlling the pneumoperitoneum pressure at 8-12 mmHg dose not affect the operation,which can reduce the impact on the recovery of gastrointestinal function and toxin absorption.

关 键 词：上消化道穿孔 气腹压 白细胞计数 C反应蛋白 降钙素原 

分 类 号：R656.1[医药卫生—急诊医学]