不同气腹压力对机体炎性细胞因子的影响

The effects of different pneumoperitoneum on the levels of inflammatory cytokines

目的观察腹腔镜手术不同CO2气腹压力对机体炎性细胞因子的影响。方法择期行腹腔镜手术患者90例,ASAⅠ或Ⅱ级,随机均分为Ⅰ、Ⅱ、Ⅲ组。麻醉诱导成功后,三组分别以10、12和15mmHg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)、术毕气腹消除后回复正常体位(T3)及术后24h(T4)采集外周静脉血,测定IL-1β、IL-6和TNF-α水平及血流动力学指标。结果与T0时比较,T1、T2时三组MAP明显升高、HR明显增快(P<0.05);同时T1～T3时Ⅲ组IL-1β、IL-6及TNF-α水平均明显升高(P<0.05)。T1～T3时Ⅰ组、Ⅱ组IL-1β、IL-6和TNF-α水平明显低于Ⅲ组(P<0.05)。结论腹腔镜手术不同的CO2气腹压力对炎性细胞因子可能有着不同的影响,压力越小影响越小。

Objective To observe the influence of different pressure of pneumoperitoneum on the levels of inflammatory cytokines. Methods Ninety patients with ASA Ⅰ orⅡ scheduled to elective laparoscopic operation were randomly allocated to groups ofⅠ, Ⅱand Ⅲ. After endotracheal intubation, different pressures were set.. 10, 12 and 15 mm Hg were given to the groups Ⅰ, Ⅱ andⅢ respectively. The blood levels of IL-1β, IL-6 and TNF-α were measured and hemodynamics were assessed at the following time points： anesthesia （T0）, after pneumoperitoneum （T1）, at the moment of operation （T2）, releasing pneumoperitoneum （T3）, and 24 h of operation （T4）. Results The values of MAP and HR at T1 and T2 were higher than at T0.（P〈0.05）, and the levels of IL-1β, IL-6 and TNF-α were higher from T1 to Ta in the three groups （P〈0.05）. The contents of IL-1β, IL-6 and TNF-α in the groups of Ⅰand Ⅱ were markedly lower than those in the group Ⅲ at T1-T3（P〈0.05）. Conclusion Different pressures during pneumoperitoneum produce different effects on inflammatory cytokines, and the lower of the pressure the less of the influence.