气腹建立前预处理对腹腔镜手术患者肝功能的影响

Effect of Pre-pneumoperitoneum Preconditioning on Liver Function in Patients Undergoing Laparoscopy

【目的】观察气腹前预处理对腹腔镜手术患者肝功能的影响。【方法】拟在全麻下行腹腔镜子宫切除术患者50例，随机分为预处理组和对照组各25例。对照组常规建立CO2气腹；预处理组在建立气腹前实施预处理：5min充气和5min放气，反复两次。检测术前、手术结束时及术后d1、d3血谷丙转氨酶（ALT）、谷草转氨酶（AST）、肿瘤坏死因子-a（TNF-a）、白细胞介素-6（IL-6）浓度。【结果】两组患者手术结束时、术后d1，ALT、AST、TNF-a、IL-6均较术前明显升高（P〈0．05），术后d3恢复到术前水平。与对照组比较，手术结束时、术后d。预处理组ALT、AST、TNF-a、IL-6显著降低（P〈0．05）。【结论】预处理可能通过抑制促炎性细胞因子的释放，对腹腔镜手术患者肝脏功能具有保护作用。

[Objective]To observe the effect of preconditioning before pneumoperitoneum on liver function in patients undergoing laparoscopic operation. [Methods] Fifty patients scheduled for laparoscopic metreetomy were randomly divided into preconditioning group and control group with 25 patients in each group. Control group underwent routine CO2 pneumoperitoneum. Preconditioning group was performed the preconditioning before pneumoperitoneum including 5min inflation and 5min deflation twice. Serum alanine aminotransferase （ALT）, aspartate aminotransferase（AST）, tumor necrosis factor-alpha（TNF-a） and interleukin-6 （IL-6） lev- els were detected before operation, at the end of the operation and d~ and d3 after operation. [Results]Com- pared with before operation, the levels of ALT, AST, TNF-a and IL-6 in both groups increased significantly at the end of the operation and dl after the operation（ P d0.05）. The above parameters d3 after operation re- covered to the levels before operation. Compared with control group, the levels of ALT, AST, TNF-a and IL- 6 in preconditioning group at the end of the operation and d1 after operation significantly decreased （ P 〈 0.05）. [Conclusion] Preconditioning may have the protective effect on liver function in patients undergoing laparoscopic operation through inhibiting the releasing of proinflammatory cytokines.