不同CO_2气腹压力对患者血清P物质浓度的影响

Effects of different CO_2 pneumoperitoneum pressure on serum concentration of substance P in patients undergoing laparoscopic resection of rectal cancer

目的观察不同二氧化碳(CO2)气腹压力对患者血清P物质(SP)浓度的影响,以探讨CO2气腹诱发术后恶心呕吐(PONV)可能发生机制。方法行腹腔镜下结肠癌根治术45例患者按照不同气腹压力随机分为3组(n=15):12mmHg(Ⅰ组)、15mmHg(Ⅱ组)和18mmHg(Ⅲ组)。主要观察术前(T1)、CO2气腹后2h(T2)、术后12h(T3)以及术后24h(T4)血清SP浓度;并随访术后恶心呕吐发生情况。结果与T1比较,在CO2气腹2h后SP浓度Ⅰ组有所下降,Ⅱ组和Ⅲ组有所上升,但和基础值比较无统计学意义(P>0.05);3组在术后T3和T4时间点SP浓度均升高,和基础值比较差异显著(P<0.01);Ⅲ组在T3和T4时间点SP浓度较Ⅱ组同时点均显著升高(P<0.01)术后6h内Ⅲ组恶心呕吐发生率较高,但3组间比较无统计学意义。结论 CO2气腹可使患者术中和术后血清SP浓度升高,可能是术后恶心呕吐高发的原因之一;因此,在保证手术操作的前提下,尽量将气腹压力维持在低水平,以减轻对胃肠活动的影响,降低术后恶心呕吐发生。

Objective To investigate different carbon dioxide（CO2） pneumoperitoneum pressure on serum concentration of substance P in patients undergoing laparoscopic resection of rectal cancer,and possible mechanism of postoperative nausea and vomiting induced（PONV）.Methods Forty-five adult patients undergoing laparoscopic resection of colon cancer were randomly divided into 3 groups（n=15）： 12 mmHg（Ⅰgroup）、15 mmHg（Ⅱgroup）和18 mmHg（Ⅲgroup） under general anesthesia.Blood samples were taken before operation（T1）、30 min after CO2.Pneumoperitoneum was established（T2）、12 h（T3） and 24 h（T4） after operation for determination of serum concentration of SP.Postoperative nausea and vomiting were recorded.Results The concentration of SP at the time of T3 and T4,three groups were higher than baseline values（P〈0.01）;Compared with the same point of Ⅱgroup,there were significant difference at the time of T3 and T4（P〈0.01）The incidence of postoperative nausea and vomiting was significantly higher in group II during the first 6h after operation.Conclusion CO2 pneumoperitoneum during laparoscopic resection of rectal cancer could increase serum SP concentration,especially the higher pressure,leading to higher incidence of postoperative nausea and vomiting.