摘要
目的比较妇科无气腹悬吊式腹腔镜和气腹腹腔镜手术对患者应激反应影响的差异。方法选择行腹腔镜下子宫肌瘤切除术患者80例,随机分为无气腹组和气腹组,每组40例。气腹组患者全麻后接受CO2气腹,而后行手术,无气腹组患者全麻后建立悬吊,而后行手术。分别评估2组患者4个时间点的应激反应[血糖、胰岛素、皮质醇和肿瘤坏死因子-α(TNF-α)情况]。结果 2组患者的血糖水平都在T1时间点升高,其中气腹组患者血糖最高点出现在T2时间点,而无气腹组出现在T3时间点。T2时,气腹组的血糖水平显著高于无气腹组(P<0.05);2组患者胰岛素水平都在T1时间点之后开始升高,2组患者胰岛素水平最高点均出现在T3时间点。T1和T2时,气腹组的胰岛素水平显著高于无气腹组(P<0.05);2组患者的皮质醇水平都在T1时间点之后开始升高,其中气腹组患者皮质醇最高点出现在T2时间点,而无气腹组出现在T3时间点。T1、T2和T3时,气腹组的皮质醇水平显著高于无气腹组(P<0.05);2组患者的TNF-α水平都在T1时间点之后开始升高,其中气腹组患者TNF-α最高点出现在T2时间点,而无气腹组出现在T3时间点。T1和T2时,气腹组的TNF-α水平显著高于无气腹组(P<0.05)。结论本研究结果显示,悬吊式无气腹腹腔镜手术可以有效降低妇科手术术中应激反应水平,增加手术安全系数,值得临床推广。
Objective To compare the effects of gynecological gasless suspended laparoscopic surgery and pneumoperitoneum laparoscopic surgery on stress reaction of patients receiving gynecological surgery .Methods Eighty patients who underwent hysteromyomectomy in our hospital from January 2014 to January 2015 were randomly divided into non-pneumoperitoneum group ( n =40) and pneumoperitoneum group ( n =40).After general anesthesia,the patients in pneumoperitoneum group received CO 2 pneumoperitoneum to undergo operation ,however ,the patients in non-pneumoperitoneum group, after general anesthesia , received abdominal wall suspension to undergo operation .The stress reaction , the levels of blood glucose, insulin, cortisol and TNF-αat 4 time points were detected and compared between two groups .Results The blood glucose levels in both groups were increased at T 1 time point,in which,the peak of blood glucose in pneumoperitoneum group appeared at T2,however, which in non-pneumoperitoneum group appeared at T 3.The blood glucose levels at T2 in pneumoperitoneum group were significantly higher than those in non-pneumoperitoneum group ( P 〈0.05).The insulin levels in both groups were increased at T 1,and the peak of insulin in both groups appeared at T 3.The insulin levels at T1 and T2 in pneumoperitoneum group were significantly higher than those in non-pneumoperitoneum group ( P 〈0.05).The cortisol levels in both groups were increased at T 1,in which the peak of blood glucose in pneumoperitoneum group appeared at T 2, however, which in non-pneumoperitoneum group appeared at T 3.The cortisol levels at T1,T2,T3 in pneumoperitoneum group were significantly higher than those in non-pneumoperitoneum group ( P 〈0.05).The TNF-αlevels in both groups were increased at T1,in which the peak of blood glucose in pneumoperitoneum group appeared at T 2,however, which in non-pneumoperitoneum group appeared at T3.The TNF-αlevels at T1,T2 in pneumoperitoneum group were significantly higher than those in non-pneumoperitoneum group ( P 〈0.05).Conclusion The suspended gasless laparoscopic surgery can effectively decrease stress reaction degree during gynecological surgery and can increase operation safety coefficient , thus, which is worth using widely in clinical practice .
出处
《河北医药》
CAS
2016年第23期3558-3560,共3页
Hebei Medical Journal
关键词
气腹
腹腔镜手术
妇科手术
应激反应
pneumoperitoneum
laparoscopic surgery
gynecological surgery
stress reaction