腹腔镜胆囊切除围手术期创伤应激、酸碱平衡和能量代谢

Operative stress response and energy metabolism after laparoscopic cholecystectomy and open cholecystectomy

目的 研究腹腔镜胆囊切除术 (LC)围手术期创伤应激激素水平、C反应蛋白和机体能量代谢与开腹胆囊切除术 (OC)的差异。 方法 慢性结石性胆囊炎患者 2 6例 (LC组 14例 ,OC组 12例 ) ,于术前 1d、术后 1d和 3d晨分别检测血C 反应蛋白 (CRP)、生长激素、皮质醇和胰岛素。同时测定静息能量消耗 (REE)和呼吸商 (RQ)。 结果 胰岛素在OC患者术后第 3天与术前比较有明显下降。生长激素、C 反应蛋白和皮质醇上升在OC术后明显高于LC(P <0 0 5 )。 2组患者静息能量消耗(REE)术后较术前显著增加 ,而术后OC患者REE明显高于LC患者 (P <0 0 5 )。 2组患者呼吸商(RQ)术后比较术前均有显著下降。LC组动脉血氧分压与氧饱和度术后 1d明显下降 ,第 3天恢复。LC组术后 3dBE明显高于OC组。 结论 腹腔镜手术创伤小 ,应激水平低 ,对患者代谢影响小 ,有益于机体应激激素、氮平衡和能量代谢的恢复。气腹可以引起体内酸血症和肺血灌流不足。

Objective To determine the level of neurohormonal operative stress response-reactive protein (CRP) and rest energy expenditure (REE) after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC). Methods Twenty-six consecutive patients with noncomplicated gallstones were randomized for LC (n=14) and OC (n=12). Plasma concentrations of somatotropin, insulin, cortisol and CRP were measured. The levels of REE were also measured. Results On the third postoperative day, the insulin levels were lower than those before operation (P<0 05). On the first postoperative day, the levels of somatotropin and cortisol were higher in OC than in LC.After operation, the parameters of somatotropin, CRP and cortisol increased compared to the preoperative period in all patients (P<0 05). On the all-postoperative day, the CRP levels were higher in OC than in LC (P<0 05). After operation, the REE level increased in OC and LC (P<0 05). On the all-postoperative day, the REE levels were higher in OC than in LC (P<0 05). Conclusions LC results in less prominent stress response and smaller metabolic interference compared to open surgery. These benefit the restoration of stress hormones, nitrogen balance, and energy metabolism. However, LC can also induce acidemia and pulmonary hypoperfusion because of pnumoperitonium during surgery.