不同气腹压下的腹腔镜阑尾切除术对急性阑尾炎患儿应激反应、胃肠功能的影响

Effect of laparoscopic appendectomy under different pneumoperitoneum pressure on stress response and gastrointestinal function in children with acute appendicitis

目的探讨急性阑尾炎患儿给予不同气腹压下的腹腔镜阑尾切除术(LA)对应激反应、胃肠功能的影响。方法选取2020年7月至2022年2月在九江市妇幼保健院接受LA治疗的90例急性阑尾炎患儿作为研究对象,采用随机数字表法分成A组(30例)、B组(30例)、C组(30例),A组术中二氧化碳(CO_(2))气腹压维持在8.0~9.0 mmHg,B组维持在>9.0~10.0 mmHg,C组维持在>10.0~11.0 mmHg,比较三组术野清晰度、应激反应及胃肠功能、局部疼痛。结果B组患儿的术野清晰度总优良率高于A组、C组,差异有统计学意义(P<0.017);A组、C组患儿术野清晰度总优良率比较,差异无统计学意义(P>0.017)。三组患儿T_(0)时的促肾上腺皮质激素(ACTH)、皮质醇(Cor)水平比较,差异无统计学意义(P>0.05);三组患儿T_(1)、T_(2)时的ACTH、Cor水平均高于本组T_(0)时,T_(2)时的ACTH、Cor水平均低于本组T_(1)时,差异有统计学意义(P<0.05);但B组T_(1)、T_(2)时的ACTH、Cor水平均低于A组、C组,差异有统计学意义(P<0.05);A组、C组T_(1)、T_(2)时的ACTH、Cor水平比较,差异无统计学意义(P>0.05)。B组患儿的肠鸣音恢复时间、肛门首次排气、排便时间均短于A组、C组,差异有统计学意义(P<0.05);A组、C组患儿肠鸣音恢复时间、肛门首次排气、排便时间比较,差异无统计学意义(P>0.05)。B组患儿局部疼痛评估总优良率高于A组、C组,差异有统计学意义(P<0.017);A组、C组患儿局部疼痛评估总优良率比较,差异无统计学意义(P>0.017)。结论急性阑尾炎患儿给予>9.0~10.0 mmHg气腹压下的LA,能够改善术野清晰度,促使胃肠功能恢复,对应激反应影响更小,局部疼痛感轻。

Objective To investigate the effect of laparoscopic appendectomy(LA)under different pneumoperitoneum pressure on stress response and gastrointestinal function in children with acute appendicitis.Methods A total of 90 children with acute appendicitis who received LA treatment in Jiujiang Maternal and Child Health Hospital from July 2020 to February 2022 were selected as the research objects.They were divided into group A(30 cases),group B(30 cases)and group C(30 cases)with random number table method.The intraoperative carbon dioxide(CO_(2))pneumoperitoneum pressure in group A was maintained at 8.0-9.0 mmHg,that in group B was maintained at>9.0-10.0 mmHg and that in group C was maintained at>10.0-11.0 mmHg.The clarity of operation field,stress response,gastrointestinal function and local pain of the three groups were compared.Results The total excellent and good rate of surgical field definition in group B was higher than that in group A and group C,and the differences were statistically significant(P<0.017).There was no significant difference in the total excellent and good rate of surgical field definition between group A and group C(P>0.017).There were no significant differences in the levels of adrenocorticotropic hormone(ACTH)and cortisol(Cor)among the three groups at T_(0)(P>0.05).The levels of ACTH and Cor in the three groups at T_(1) and T_(2) were higher than those at T_(0),and the levels of ACTH and Cor at T_(2) were lower than those at T_(1),and the differences were statistically significant(P<0.05).However,the levels of ACTH and Cor in group B at T_(1) and T_(2) were lower than those in group A and group C,and the differences were statistically significant(P<0.05).There was no significant difference in the levels of ACTH and Cor between group A and group C at T_(1) and T_(2)(P>0.05).The recovery time of bowel sounds,the time of first anal exhaust and defecation in group B were shorter than those in group A and group C,and the differences were statistically significant(P<0.05).There was no significant difference in the recovery time of bowel sounds,the first anal exhaust and defecation time between group A and group C(P>0.05).The total excellent and good rate of local pain assessment in group B was higher than that in group A and group C,and the differences were statistically significant(P<0.017).There was no significant difference in the total excellent and good rate of local pain assessment between group A and group C(P>0.017).Conclusion The application of LA under pneumoperitoneum pressure of>9.0-10.0 mmHg in children with acute appendicitis can improve the clarity of the surgical field,promote the recovery of gastrointestinal function,have less impact on the stress response,and reduce local pain.