二氧化碳气腹对子宫肌瘤合并原发性高血压肠黏膜屏障的影响

Effect of CO_(2)pneumoperitoneum on intestinal mucosal barrier in patients with uterine leiomyoma complicated with essential hypertension

目的探讨腹腔镜手术二氧化碳气腹对子宫肌瘤合并原发性高血压(EH)病人肠黏膜屏障的影响。方法选取2019年6―12月山西医科大学第二医院拟在全麻下行腹腔镜子宫肌瘤剔除术的多发性子宫肌瘤合并EH病人20例纳入EH组,同期相同病例的非高血压病人20例纳入对照组;两组均常规行静脉麻醉诱导和维持,分别于麻醉诱导前10 min(T_(1)),气腹解除后1 h(T_(2)),气腹解除后24 h(T_(3))取桡静脉血5 mL,测定两组病人血清紧密连接蛋白-1(Claudin-1)蛋白和肿瘤坏死因子-α(TNF-α)的含量并记录两组病人术后排气功能恢复时间。结果与T_(1)比较,T_(2)、T_(3)时刻两组病人TNF-α含量均增高(P<0.01),Claudin-1含量均减低(P<0.01);与对照组比较,在相同时间EH组TNF-α含量[T_(1)(11.57±1.20)ng/L比(10.24±1.09)ng/L,T_(2)(13.30±1.57)ng/L比(11.77±1.43)ng/L,T_(3)(12.55±1.93)ng/L比(11.15±1.15)ng/L]和术后排气功能恢复时间[(20.35±3.20)h比(16.85±2.60)h]高于对照组,Claudin-1含量低于对照组[T_(1)(99.60±11.84)ng/L比(110.40±8.42)ng/L,T_(2)(83.16±14.56)ng/L比(95.56±10.26)ng/L,T_(3)(86.10±12.70)ng/L比(99.35±10.72)ng/L](P<0.01)。结论妇科腹腔镜手术二氧化碳气腹会通过增加炎性因子的释放加强炎症反应,并抑制肠黏膜屏障Claudin-1蛋白的表达使病人肠黏膜屏障功能损伤;而当病人合并EH时,气腹引起的肠黏膜屏障损伤加重。

Objective To investigate the effect of CO_(2) pneumoperitoneum on intestinal mucosal barrier in patients with uterine leio-myoma complicated with essential hypertension(EH)by laparoscopy.Methods Twenty patients with multiple uterine leiomyoma com-plicated by laparoscopic myomectomy EH general anesthesia in the Second Hospital of Shanxi Medical University from June to Decem-ber 2019 were included in EH group.At the same time,20 non-hypertensives were included in the control group.Both groups were rou-tinely induced and maintained by intravenous anesthesia,10 min before anesthesia induction(T_(1)),1 h after pneumoperitoneum release(T_(2)),and 24 h after pneumoperitoneum release(T_(3)),radial venous blood was taken for 5 mL.The contents of serum Claudin-1 protein and TNF-αin both groups were determined and the recovery time of exhaust function was recorded.Results Compared with the T_(1),the TNF-αcontent of the two groups increased(P<0.01)and the Claudin-1 content decreased(P<0.01).Compared with the control group,the TNF-αcontent[T_(1)(11.57±1.20)ng/L vs.(10.24±1.09)ng/L,T_(2)(13.30±1.57)ng/L vs.(11.77±1.43)ng/L,T_(3)(12.55±1.93)ng/L vs.(11.15±1.15)ng/L]and postoperative exhaust function recovery time[(20.35±3.20)h vs.(16.85±2.60)h]were higher than those of the control group(P<0.01).Compared with the control group,the Claudin-1 content was lower than that of the control group[T_(1)(99.60±11.84)ng/L vs.(110.40±8.42)ng/L,T_(2)(83.16±14.56)ng/L vs.(95.56±10.26)ng/L,T_(3)(86.10±12.70)ng/L vs.(99.35±10.72)ng/L](P<0.01).Conclusion Gynecological laparoscopic surgery CO_(2)pneumoperitoneum can strengthen inflammatory response by increasing the release of inflammatory factors and inhibit the expression of intestinal mucosal barrier Claudin-1 protein,which can damage the function of intestinal mucosal barrier in patients,while patients are combined with EH,the intestinal mucosal barrier injury caused by pneumoperitoneum is aggravated.