目的探讨妇科腹腔镜手术头低脚高位和CO2气腹对循环的影响。方法选择于北京妇产医院行妇科腹腔镜手术的10例ASAⅠ级的健康女性为研究对象,以瑞芬太尼和依托咪酯静脉诱导气管插管和维持。监测创建气腹前平躺时(T1)、头低10°时(T2)...目的探讨妇科腹腔镜手术头低脚高位和CO2气腹对循环的影响。方法选择于北京妇产医院行妇科腹腔镜手术的10例ASAⅠ级的健康女性为研究对象,以瑞芬太尼和依托咪酯静脉诱导气管插管和维持。监测创建气腹前平躺时(T1)、头低10°时(T2)、头低20°时(T3)、手术开始时、创建气腹后气腹压10 mm Hg及15 mm Hg平躺时、头低10°时及头低20°时(T4-1、T4-2、T4-3和T5-1、T5-2、T5-3)的心率、收缩压(SBP)、舒张压(DBP)、平均动脉压、心排量、心指数、每搏量、每搏指数、每搏量变异和脑电双频指数(BIS)。结果腹腔充气前,仰卧位、头低脚10°和20°三个时点,各项血流动力学参数无明显变化;充气前SBP为(105.8±4.0)mm Hg、DBP为(64.1±2.2)mm Hg,充气后SBP为(121.4±4.1)mm Hg、DBP为(81.3±3.6)mm Hg,充气后血压明显高于充气前,差异有高度统计学意义(P<0.01),但是充气后体位对各项血流动力学参数并无明显影响。气腹压12 mm Hg和15 mm Hg相比,血流动力学无明显改变。结论无合并症的患者可以较好地耐受常规的头低脚高位对机体的影响,腹腔镜下CO2气腹对患者的循环影响较大,如果高气腹压持续时间较长,会对患者造成不良影响,特别是老年人、高血压及心脏病患者。展开更多
目的探讨不同气腹压腹腔镜技术对结直肠癌外周血微转移的影响。方法将入组的80例结直肠癌患者随机分成A、B、C、D组,每组20例,A组腹腔镜术中气腹压维持在14mm Hg;B组腹腔镜术中气腹压维持在12mm Hg;C组腹腔镜术中气腹压维持在10mm Hg;D...目的探讨不同气腹压腹腔镜技术对结直肠癌外周血微转移的影响。方法将入组的80例结直肠癌患者随机分成A、B、C、D组,每组20例,A组腹腔镜术中气腹压维持在14mm Hg;B组腹腔镜术中气腹压维持在12mm Hg;C组腹腔镜术中气腹压维持在10mm Hg;D组为对照组（传统开腹手术组）,采用RT-PCR方法检测不同气腹压组腹腔镜结直肠癌术患者外周静脉血中CEA m RNA及CK20 m RNA的表达情况,并与开腹组比较。结果 A、B、C、D四组比较术前CEA m RNA表达无统计学差异（χ2=0.559,P=0.906）;四组比较术中CEA m RNA表达无统计学差异（χ2=0.579,P=0.901）;四组比较术后CEA m RNA表达无统计学差异（χ2=1.522,P=0.677）;四组术中、术后CEA m RNA表达阳性率与术前比较无统计学差异比较（χ2=1.146,P=0.979）;A、B、C、D四组术前比较外周静脉血CK20m RNA表达无统计学差异（χ2=0.955,P=0.812）;四组术中比较外周静脉血CK20m RNA表达无统计学差异（χ2=1.023,P=0.796）;术后比较外周静脉血CK20m RNA表达无统计学差异（χ2=2.083,P=0.555）;四组术中、术后外周静脉血CK20m RNA表达阳性率与术前比较亦无统计学差异比较（χ2=0.681,P=0.995）。结论与开腹手术比较,不同气腹压（10-14mm Hg）腹腔镜结直肠癌根治术不增加患者外周静脉血CEAm RNA及CK20m RNA表达。展开更多
目的探讨不同压力CO2缺血预处理对气腹模型大鼠肝脏缺血再灌注损伤的影响及可能机制。方法成年健康雄性SD大鼠30只,采用随机数字表法分为5组:空白对照组(C组)于麻醉后插入气腹针;气腹对照组(Pp组)以10 mm Hg气腹压力建立CO2气腹60 min;...目的探讨不同压力CO2缺血预处理对气腹模型大鼠肝脏缺血再灌注损伤的影响及可能机制。方法成年健康雄性SD大鼠30只,采用随机数字表法分为5组:空白对照组(C组)于麻醉后插入气腹针;气腹对照组(Pp组)以10 mm Hg气腹压力建立CO2气腹60 min;低压预处理组(L-IP组)、中压预处理组(M-IP组)、高压预处理组(H-IP组)在建立CO2气腹前,分别以5、10、15 mm Hg充气5 min放气5 min,连续3个循环。各组恢复灌注60 min后取肝组织,行HE染色光镜下观察肝组织病理学变化,分光光度法测定超氧化歧化酶(SOD)活性、总抗氧化物能力(T-AOC)及丙二醛(MDA)含量,免疫组化、Western blot法检测Bcl-2、Bax蛋白表达水平,RT-PCR法检测IL-1β、IL-6 m RNA表达水平。结果除C组外,Pp组与各IP组大鼠肝组织均出现病理学改变,其中,各IP组的损伤程度明显轻于Pp组;与Pp组比较,各IP组SOD活性、T-AOC升高及MDA含量下降,Bcl-2蛋白表达增加、Bax蛋白表达减少且Bcl-2/Bax比值升高,IL-1β及IL-6 m RNA表达下调(P均<0.05);与L-IP组、H-IP组比较,M-IP组SOD、TAOC、Bcl-2及Bcl-2/Bax比值均增加,MDA、Bax、IL-1β及IL-6 m RNA均减少。结论 CO2缺血预处理可减轻气腹模型大鼠肝脏缺血再灌注损伤,其中10 mm Hg压力的CO2预处理抗损伤作用更明显,其机制与减弱氧化应激反应,上调Bcl-2抗凋亡蛋白表达,下调Bax促凋亡蛋白表达及炎症细胞因子IL-1β、IL-6 m RNA的表达,减少细胞凋亡和降低炎性反应有关。展开更多
Object: The authors studied the influence of CO2 pneumoperitoneum on intracellular pH and signal transduction arising from cancer cell multiplication in laparoscopic tumor operation. Method: They set up a simulation o...Object: The authors studied the influence of CO2 pneumoperitoneum on intracellular pH and signal transduction arising from cancer cell multiplication in laparoscopic tumor operation. Method: They set up a simulation of pneumoperitoneum under different CO2 pressure, and then measured the variation of intracellular pH (pHi) at different time and the activity of protein kinase C (PKC) and protein phosphatase 2a (PP2a) at the end of the pneumoperitoneum. After 1 week, the concentration of cancer cells in the culture medium was calculated. Result: When the pressure of CO2 pneumoperitoneum was 0, 10, 20, 30 mmHg respectively, the average pHi was 7.273, 7.075, 6.783, 6.693 at the end of the pneumoperitoneum; PKC activity was 159.4, 168.5,178.0, 181.6 nmol/(g.min) and PP2a was 4158.3, 4066.9, 3984.0, 3878.5 nmol/(g.min) respectively. After 1 week, the cancer cells concentration was 2.15×105, 2.03×105, 2.20×105, 2.18×105 L-1. Conclusion: CO2 pneumoperitoneum could promote acidosis in cancer cells, inducing the activation of protein kinase C and deactivation of protein phosphatase 2a, but it could not accelerate the mitosis rate of the cancer cells.展开更多
文摘目的探讨妇科腹腔镜手术头低脚高位和CO2气腹对循环的影响。方法选择于北京妇产医院行妇科腹腔镜手术的10例ASAⅠ级的健康女性为研究对象,以瑞芬太尼和依托咪酯静脉诱导气管插管和维持。监测创建气腹前平躺时(T1)、头低10°时(T2)、头低20°时(T3)、手术开始时、创建气腹后气腹压10 mm Hg及15 mm Hg平躺时、头低10°时及头低20°时(T4-1、T4-2、T4-3和T5-1、T5-2、T5-3)的心率、收缩压(SBP)、舒张压(DBP)、平均动脉压、心排量、心指数、每搏量、每搏指数、每搏量变异和脑电双频指数(BIS)。结果腹腔充气前,仰卧位、头低脚10°和20°三个时点,各项血流动力学参数无明显变化;充气前SBP为(105.8±4.0)mm Hg、DBP为(64.1±2.2)mm Hg,充气后SBP为(121.4±4.1)mm Hg、DBP为(81.3±3.6)mm Hg,充气后血压明显高于充气前,差异有高度统计学意义(P<0.01),但是充气后体位对各项血流动力学参数并无明显影响。气腹压12 mm Hg和15 mm Hg相比,血流动力学无明显改变。结论无合并症的患者可以较好地耐受常规的头低脚高位对机体的影响,腹腔镜下CO2气腹对患者的循环影响较大,如果高气腹压持续时间较长,会对患者造成不良影响,特别是老年人、高血压及心脏病患者。
文摘目的探讨不同气腹压腹腔镜技术对结直肠癌外周血微转移的影响。方法将入组的80例结直肠癌患者随机分成A、B、C、D组,每组20例,A组腹腔镜术中气腹压维持在14mm Hg;B组腹腔镜术中气腹压维持在12mm Hg;C组腹腔镜术中气腹压维持在10mm Hg;D组为对照组（传统开腹手术组）,采用RT-PCR方法检测不同气腹压组腹腔镜结直肠癌术患者外周静脉血中CEA m RNA及CK20 m RNA的表达情况,并与开腹组比较。结果 A、B、C、D四组比较术前CEA m RNA表达无统计学差异（χ2=0.559,P=0.906）;四组比较术中CEA m RNA表达无统计学差异（χ2=0.579,P=0.901）;四组比较术后CEA m RNA表达无统计学差异（χ2=1.522,P=0.677）;四组术中、术后CEA m RNA表达阳性率与术前比较无统计学差异比较（χ2=1.146,P=0.979）;A、B、C、D四组术前比较外周静脉血CK20m RNA表达无统计学差异（χ2=0.955,P=0.812）;四组术中比较外周静脉血CK20m RNA表达无统计学差异（χ2=1.023,P=0.796）;术后比较外周静脉血CK20m RNA表达无统计学差异（χ2=2.083,P=0.555）;四组术中、术后外周静脉血CK20m RNA表达阳性率与术前比较亦无统计学差异比较（χ2=0.681,P=0.995）。结论与开腹手术比较,不同气腹压（10-14mm Hg）腹腔镜结直肠癌根治术不增加患者外周静脉血CEAm RNA及CK20m RNA表达。
文摘目的探讨不同压力CO2缺血预处理对气腹模型大鼠肝脏缺血再灌注损伤的影响及可能机制。方法成年健康雄性SD大鼠30只,采用随机数字表法分为5组:空白对照组(C组)于麻醉后插入气腹针;气腹对照组(Pp组)以10 mm Hg气腹压力建立CO2气腹60 min;低压预处理组(L-IP组)、中压预处理组(M-IP组)、高压预处理组(H-IP组)在建立CO2气腹前,分别以5、10、15 mm Hg充气5 min放气5 min,连续3个循环。各组恢复灌注60 min后取肝组织,行HE染色光镜下观察肝组织病理学变化,分光光度法测定超氧化歧化酶(SOD)活性、总抗氧化物能力(T-AOC)及丙二醛(MDA)含量,免疫组化、Western blot法检测Bcl-2、Bax蛋白表达水平,RT-PCR法检测IL-1β、IL-6 m RNA表达水平。结果除C组外,Pp组与各IP组大鼠肝组织均出现病理学改变,其中,各IP组的损伤程度明显轻于Pp组;与Pp组比较,各IP组SOD活性、T-AOC升高及MDA含量下降,Bcl-2蛋白表达增加、Bax蛋白表达减少且Bcl-2/Bax比值升高,IL-1β及IL-6 m RNA表达下调(P均<0.05);与L-IP组、H-IP组比较,M-IP组SOD、TAOC、Bcl-2及Bcl-2/Bax比值均增加,MDA、Bax、IL-1β及IL-6 m RNA均减少。结论 CO2缺血预处理可减轻气腹模型大鼠肝脏缺血再灌注损伤,其中10 mm Hg压力的CO2预处理抗损伤作用更明显,其机制与减弱氧化应激反应,上调Bcl-2抗凋亡蛋白表达,下调Bax促凋亡蛋白表达及炎症细胞因子IL-1β、IL-6 m RNA的表达,减少细胞凋亡和降低炎性反应有关。
基金Project supported by Research and Development Funds of Second Affiliated Hospital, School of Medicine, Zhejiang University, China
文摘Object: The authors studied the influence of CO2 pneumoperitoneum on intracellular pH and signal transduction arising from cancer cell multiplication in laparoscopic tumor operation. Method: They set up a simulation of pneumoperitoneum under different CO2 pressure, and then measured the variation of intracellular pH (pHi) at different time and the activity of protein kinase C (PKC) and protein phosphatase 2a (PP2a) at the end of the pneumoperitoneum. After 1 week, the concentration of cancer cells in the culture medium was calculated. Result: When the pressure of CO2 pneumoperitoneum was 0, 10, 20, 30 mmHg respectively, the average pHi was 7.273, 7.075, 6.783, 6.693 at the end of the pneumoperitoneum; PKC activity was 159.4, 168.5,178.0, 181.6 nmol/(g.min) and PP2a was 4158.3, 4066.9, 3984.0, 3878.5 nmol/(g.min) respectively. After 1 week, the cancer cells concentration was 2.15×105, 2.03×105, 2.20×105, 2.18×105 L-1. Conclusion: CO2 pneumoperitoneum could promote acidosis in cancer cells, inducing the activation of protein kinase C and deactivation of protein phosphatase 2a, but it could not accelerate the mitosis rate of the cancer cells.
