CO2气腹对腹腔镜手术患者血清胃动素浓度的影响

Effects of CO2 pneumoperitoneum on serum concentration of motilin in patients undergoing laparoscopic cholecystectomy

目的观察CO2气腹对腹腔镜手术患者血清胃动素浓度的影响，以探讨CO2气腹诱发腹腔镜术后高恶心呕吐发生率的机制。方法全麻下单纯胆囊切除术患者20例，随机分为2组（n=10），开腹胆囊切除术组（Ⅰ组）和腹腔镜胆囊切除术组（Ⅱ组）。Ⅰ组分别于术前（L）、胆囊切除后（T2）、术毕（T3）、术后12h（T4）及术后24h（T5）采集静脉血4ml；Ⅱ组分别于术前（L）、CO2气腹后25rain（T2）、CO2放气后15min（T3）、术后12h（T4）及术后24h（L）采集静脉血4ml，测定血清胃动素浓度，观察术后恶心、呕吐的发生情况。结果与T1时比较，Ⅰ组T3时血清胃动素浓度升高，Ⅱ组T2-4时血清胃动素浓度升高（P〈0．05或0．01）；与Ⅰ组比较，Ⅱ组T2-4时血清胃动素浓度升高，T4时恶心、呕吐的发生率升高（P〈0．05或0．01）。结论CO2气腹可引起腹腔镜手术患者术中和术后血清胃动素浓度升高，可能是诱发腹腔镜术后恶心呕吐发生的机制之一。

Objective To evaluate the effects of CO2 peumoperitoneum on serum concentration of motilin （MTL） in patients undergoing laparoscopic cholecystectomy. Methods Twenty ASA Ⅰ or Ⅱ patients aged 32-58 yr weighing 52-78 kg undergoing laparoscopic cholecystectomy under general anesthesia were randomly divided into 2 groups （n = 10 each ）： group Ⅰ traditional transabdominal cholecystectomy and group Ⅱ laparoscopic cholecystectomy. The patients were premedicated with intramuscular atropine 0.5 mg. Anesthesia was induced with fentanyl 2-4μg/kg and etomidate 0.3 mg/kg. Tracheal intubation was facilitated with vecuronium 0.1 mg/kg. The patients were mechanically ventilated. Anesthesia was maintained with 1%-2% isoflurane and intermittent iv boluses of fentanyl and vecuronium. Intra-abdominal pressure was maintained at 12 mm Hg during operation. Blood samples were taken before operation （ T1 , baseline）, immediately after gallbladder was removed or 25 min after CO2 pneumoperitoneum was established （T2）, at the end of operation or 15 min after deflation （T3 ） and 12 h and 24 h after operation （ T4, T5 ） for determination of serum concentration of MTL. Postoperative nausea and vomiting were recorded. Results The two groups were comparable with respect to sex ratio, age and body weight. The serum concentration of MTL was significantly increased at T3 in group Ⅰ and at T2-4 in group Ⅱ as compared with the baseline values at T1 （ P 〈 0.05 or 0.01 ） . The serum concentration of MTL was significantly higher in group Ⅱ than in group Ⅰ at T2-4 The incidence of postoperative nausea and vomiting was significantly higher in group Ⅱ than in group Ⅰ during the first 12 h after operation. Conclusion CO2 pneumoperitoneum during laparoscopic cholecystectomy can increase serum MTL concentration, leading to higher incidence of postoperative nausea and vomiting.