妇科腹腔镜手术不同气腹压力对TNF-α、缺血修饰蛋白水平的影响及意义

The influence of gynecological laparoscopic surgery under different pneumoperitoneum pressure on TNF alpha,ischemia- modified protein level and its significance

目的探讨妇科腹腔镜手术不同气腹压力对肿瘤坏死因子-α(TNF-α)、缺血修饰蛋白水平(IMA)的影响及意义。方法选择2010年1月至2013年12月期间行腹腔镜手术的120例患者为研究对象。将120例患者按照随机数字表法随机分为三组各40例。A组(低气腹压力组):40例,术中给予10 mm Hg气腹压力;B组(中气腹压力组):40例,术中给予12 mm Hg气腹压力;C组(高气腹压力组):40例,术中给予15 mm Hg气腹压力。检测三组术前、术中30min、术后12 h、术后24 h血IMA、TNF-α水平,并对术后12 h血IMA、TNF-α水平与气腹压力进行相关性分析。结果三组患者在年龄、手术时间、体质量指数方面比较无统计学意义(P>0.05),但C组胃胀气、恶心呕吐发生率高于A组和B组(P<0.05);A组、B组、C组三组TNF-α水平在术前、术后均出现一定幅度的变化,三组术前TNF-α水平比较无统计学意义(P>0.05),A组、B组、C组三组术中、术后12 h、术后24 h TNF-α水平均较术前上升(P<0.05),但C组TNF-α水平波动幅度最大(P<0.05),三组术后24 h TNF-α水平出现回落,且三组间比较无统计学差异(P>0.05);对术后12 h血IMA、TNF-α水平与气腹压力进行相关性分析,结果显示,术后12 h血IMA、TNF-α水平与气腹压力呈正相关(P<0.05);血IMA水平与血TNF-α水平呈正相关(P<0.05)。结论低气腹压力对机体创伤小,机体应激反应轻,因此妇科腹腔镜手术中应考虑气腹压力对机体可能造成的影响,在条件允许的情况下,宜采取低气腹压力,以减少对机体的损害。

Objective To study the influence of gynecological laparoscopic surgery under different pneumoperitoneum pressure on TNF al- pha, ischemia modified protein level and its significance. Methods 120 cases of patients for laparoscopic surgery during January 2010 and December 2013 were selected as the research object. According to random number table method 120 patients were randomly divided into three groups （n =40）. Group A （low pneumoperitoneum pressure group） ： 40 cases, intraoperative given 10 mmHg pneumoperitoneum pressure; Group B （moderate pneumoperitoneum pressure group）, 40 patients, intraoperative given 12 mmHg pneumoperitoneum pressure; Group C （high pneumo- peritoneum pressure group） ： 40 cases, intraoperative given 15 mmHg pneumoperitoneum pressure. Preoperative and intraoperative 30 min and postoperative 12 h and 24 h blood IMA, TNF alpha level in three groups were tested, and the correlation analysis of postoperative 12 h blood IMA, TNF alpha levels and pneumoperitoneum pressure were made. Results Three groups patients＇terms of age, operation time, body mass index were of no statistical significance （ P 〉 0.05）, but the flatulence, nausea, and vomiting incidence in group C were higher than that of group A and group B （ P 〈0. 05 ）. TNF alpha level on preoperative and postoperative changes in group A, group B and group C was in a certain range. The preoperative TNF alpha level of three groups is of no statistical significance （ P 〉 0.05 ）. The intraoperative and postoperative 12 h, 24 h postop- erative TNF alpha levels in group A, group B and group C increased compared with preoperative group C （ P 〈 0.05 ）, but the level of TNF alpha volatility was biggest （ P 〈 0.05 ）. 24 HTNF alpha level of the three groups of postoperative fall, and the comparison between the three groups had no statistical difference （ P 〉 0.05 ）. For blood IMA 12 h after, the level of TNF alpha and pneumoperitoneum pressure correlation analysis, the results showed that after 12 h blood IMA, TNF alpha level was positively correlated with pneumoperitoneum pressure （ P 〈0.05 ）. IMA levels of blood and blood TNF alpha levels were positively correlated （ P 〈 0.05）. Conclusion Low pneumoperitoneum pressure has light body trauma, and the body~ stress response is light. Therefore, the possible impact of pneumoperitoneum pressure should be considered in gynecological laparo- scopic surgery. This method is within the conditions. This method is appropriate to use low pneumoperitoneum pressure in order to reduce the dam- age to the body.