[1]谢涛 肖金苗﹡.腹腔镜手术不同气腹压力对IL1β，IL6和TNFα的影响[J].中国微创外科杂志,2014,14(11):1028-1054.
　Xie Tao,Xiao Jinmiao..Effects of Different Pneumoperitoneum Pressures on IL1, IL6, and TNFα[J].Chinese Journal of Minimally Invasive Surgery,2014,14(11):1028-1054.
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腹腔镜手术不同气腹压力对IL1β，IL6和TNFα的影响()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
14
期数:
2014年11期
页码:
1028-1054
栏目:
论著
出版日期:
2014-11-20

文章信息/Info

Title:
Effects of Different Pneumoperitoneum Pressures on IL1, IL6, and TNFα
作者:
谢涛 肖金苗﹡
湖北省黄石市第二医院麻醉科，黄石435002
Author(s):
Xie Tao;  Xiao Jinmiao.
Department of Anesthesiology, Second Hospital of Huangshi, Huangshi 435002, China
关键词:
腹腔镜手术; 气腹压力; 细胞因子; 应激反应
Keywords:
Laparosopic surgery; Pneumoperitoneum; Cytokine; Stress reaction
分类号:
R614.1
文献标志码:
A
摘要:
目的探讨腹腔镜手术不同压力CO2气腹对患者机体的IL1β，IL6和TNFα的影响。方法2010年10月～2012年6月择期腹腔镜手术90例，ASA Ⅰ或Ⅱ级，按病例时间分为10、12、15 mm Hg组。麻醉诱导成功后，3组分别以10、12和15 mm Hg气腹压力建立CO2气腹进行手术，分别于麻醉成功后（T0）、气腹建立后（T1）、摆放手术体位前（T2）、手术完毕气腹消除后（T3）、术后24 h（T4）采集外周静脉血，测定白细胞介素1β（IL1β），白细胞介素6（IL6）和肿瘤坏死因子α（TNFα）水平，以及血流动力学指标并对测定结果进行统计学分析。结果组间比较：3组患者不同时点MAP、HR、PETCO2均无统计学差异（P＞0.05）；组内比较：3组患者不同时点MAP、HR有显著差异（P＜0.05），PETCO2无统计学差异（P＞005）。组间比较：3组患者T1~T3时点IL1β、IL6、TNFα均有统计学差异（P＜0.05）；组内比较：3组IL1β在T1、T2时点与T0比较差异有统计学意义（P＜0.05），10、12 mm Hg组不同时点IL6无统计学差异（P＞0.05），15 mm Hg组在T1、T2、T3时点IL6显著高于T0时点（P＜0.05），12、15 mm Hg组TNFα T1、T2、T3时点与T0比较有统计学差异（P＜0.05），10 mm Hg组仅T0与T1时点有显著差异（P＜0.05）。结论腹腔镜手术时气腹压力较小的应激反应较轻，以10 mm Hg为宜。
Abstract:
ObjectiveTo explore the effects of different pressures of carbon dioxide pneumoperitoneum under laparoscopic surgery on IL1β, IL6, and TNFα.MethodsNinety patients with ASA Ⅰ or Ⅱ who were scheduled to elective operation under laparoscopic surgery from October 2010 to June 2012 were randomly divided into three groups. After endotracheal intubation, different carbon dioxide pressures, 10 mm Hg, 12 mm Hg, and 15 mm Hg, were orderly given to group 1, 2, and 3 to build pneumoperitoneum. The serum levels of IL1β, IL6, and TNFα, as well as hemodynamic parameters, were assessed at the time after anesthesia (T0), after pneumoperitoneum development (T1), of position placement before operation (T2), after dismissing pneumoperitoneum (T3), and 24 hours after operation (T4), respectively. ResultsThe measures of MAP, HR, and PETCO2 had no significant differences between each other of the three groups (P>0.05), and the MAP and HR results showed significant differences among the three groups at different time points (P<0.05) whereas no difference for PETCO2 values (P>0.05). There were statistical significances between the three groups in levels of IL1β, IL6, and TNFα at time points of T1, T2, T3, and T4, respectively (P<0.05). As compared with T0, there were significant differences in levels of IL1β at the time points of T1 and T2 in the three groups (P<0.05). There were no significant differences in IL6 levels between the group 1 and group 2 at every time points (P>0.05). In the group 3, the levels of IL6 were significantly higher at time points of T1, T2, and T3 than at T0 (P<0.05). In the group 2 and group 3, the levels of TNFα at T1, T2, and T3 were significantly different from at T0 (P<0.05), whereas in the group 1, significant difference was seen only between the time points of T0 and T1 (P<0.05).ConclusionLow pneumoperitoneum pressure leads to minor stress effects. A 10 mm Hg carbon dioxide pneumoperitoneum is recommended.

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备注/Memo

备注/Memo:
基金项目：黄石市医药卫生立项科研项目；黄科技发农2013【1】号﹡通讯作者，Email:xietao33@126.com
更新日期/Last Update: 2014-11-20