CO_2气腹对老年急性阑尾炎患者术后炎症反应及免疫应激反应的影响

Effect of CO_2 Pneumoperitoneum on Postoperative Inflammatory Reaction and Immune Response of Elderly Patients with Acute Appendicitis

目的:研究CO_2气腹对老年急性阑尾炎患者术后炎症反应及免疫应激反应的影响,为临床治疗提供依据。方法:选取2015年1月到2016年3月我院收治的老年急性阑尾炎患者130例,按照随机数字表法将患者分为研究组和对照组,每组65例,对照组给予常规开腹阑尾炎切除术,研究组应用CO_2气腹下腹腔镜下阑尾炎切除术,比较两组术前、术后1天、3天和5天白细胞计数、中性粒细胞计数、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平。结果:术后1天两组白细胞计数、中性粒细胞计数、IL-10和TNF-α水平均明显升高,比较差异具有统计学意义(P<0.05),研究组术后1天白细胞计数和中性粒细胞计数与对照组比较,差异无统计学意义(P>0.05),研究组术后1天TNF-α和IL-10水平显著低于对照组,比较差异具有统计学意义(P<0.05);术后3天、5天与术后1天相比,两组白细胞计数、中性粒细胞计数、IL-10和TNF-α水平均明显降低,术后3天与术前比较差异无统计学意义(P>0.05),术后5天与术前比较差异具有统计学意义(P<0.05),术后3天和5天研究组白细胞计数、中性粒细胞计数、IL-10和TNF-α均显著低于对照组,比较差异具有统计学意义(P<0.05)。结论:CO_2气腹能有效降低急性阑尾炎患者术后炎症反应和免疫应激反应,改善患者预后。

Objective： To study the effect of CO2 pneumoperitoneum on postoperative inflammatory reaction and immune response of elderly patients with acute appendicitis, and to provide basis for clinical treatment. Methods： 130 elderly patients with acute appendicitis who were treated in our hospital from January 2015 to March 2016 were selected, according to the random number table method,they were divided into study group and control group,with 65 patients in each group. The patients in control group were treated with conventional open appendectomy, while the patients in study group were treated with CO2 pneumoperitoneum laparoscopic appendectomy. The white blood cell count, neutrophil count, interleukin -10 （IL-10） and tumor necrosis factor -α（TNF-α） level were compared between the two groups before and after operation 1 d, 3 d and 5 d. Results： The white blood cell count, neutrophil count, levels of IL-10 and TNF-α in the two groups were significantly increased at 1 d after operation, the differences were statistically significant（P〈0.05）. The white blood cell count and neutrophil count were compared with the control group at 1 d after operation, the differences were not statistically significant （P〉0.05）. The levels of TNF-α and IL-10 in the study group were significantly lower than that in the control group at 1 d after operation, the differences were statistically significant （P〈0.05）; 3 d, 5 d after operation compared with 1 d, the white blood cell count, neutrophil count, levels of IL-10 and TNF-α levels in the two groups were significantly reduced, there was no significant difference between the 3 d after operation and before operation （P〉0.05）, the difference between the 5 d after operation and before operation was statistically significant（P〈0.05）. The white blood cell count, neutrophil count, 1L-10 and TNF-α in the study group were significantly lower than those in the control group at 3 d and 5 d after operation, the differences were statistically significant（P〈0.05）. Conclusion： CO2 pneumoperitoneum can effectively reduce postoperative inflammatory reaction and immune response of elderly patients with acute appendicitis, and improve the prognosis of patients.