不同CO2压力对腹腔镜直肠癌根治术患者术中应激反应及胃肠功能的影响

目的对比分析腹腔镜直肠癌根治术中不同二氧化碳(CO2)气腹压力对患者应激反应及胃肠功能的影响。方法选择2014年3月至2019年4月在四川省安岳县人民医院接受腹腔镜根治术治疗的93例直肠癌患者,根据随机数字表法将其分为低、中、高气腹压力组,每组31例。所有患者手术方式、麻醉方法、用药等均一致,术中低气腹压力组CO2气腹压力为10 mmHg,中气腹压力组为12 mmHg,高气腹压力组为15 mmHg;记录并比较3组患者气腹持续时间、术中失血量、手术时间,分别于入室时(T0)、注气针穿刺时(T1)、气腹成功建立时(T2)及放气后10 min(T3)采集患者血液样本,检测患者皮质醇、肾上腺素、血浆D-乳酸水平;记录并比较3组患者术后首次排气、排便、肠鸣音、进食等用时及术后并发症发生情况。结果各组患者手术相关指标及并发症发生率比较差异无统计学意义(P>0.05);3组在T1、T2、T3的皮质醇、肾上腺素、血浆D-乳酸水平均较T0升高,差异有统计学意义(P<0.05);高气腹压力组各时点皮质醇、肾上腺素水平均高于其他组,差异有统计学意义(P<0.05);高气腹压力组胃肠功能恢复用时最长(P<0.05)。结论在10~15 mmHg的CO2气腹压力范围内均可顺利开展腹腔镜直肠癌根治术,且不会影响患者术后胃肠道功能的恢复,但随着压力的增加,患者术中应激反应加重,肠黏膜损伤情况较明显,气腹压力应以10~12 mmHg为宜。

Effect of different CO2 pressure on intraoperative stress response and gastrointestinal function in patients with laparoscopic radical resection for rectal cancer

Objective To compare the effect of different carbon dioxide(CO2)pressure on intraoperative stress response and gastrointestinal function in patients with laparoscopic radical resection for rectal cancer.Methods A total of 93 patients with rectal cancer who underwent laparoscopic radical resection in the people′s hospital of Anyue county from March 2014 to April 2019 were selected as the subjects.These patients were divided into low pneumoperitoneum pressure group,middle pneumoperitoneum pressure group and high pneumoperitoneum pressure group according to the random number table method,with 31 cases in each group.The surgical method,anesthesia method and medication were the same for all patients.The intraoperative pneumoperitoneum pressure of low pneumoperitomeum pressure group,middle pneumoperitomeum pressure group and high pneumoperitomeum pressure group was 10 mmHg,12 mmHg,and 15 mmHg,respectively.The duration of pneumoperitoneum,intraoperative blood loss,and operative time of the three groups were recorded and compared.Blood samples were collected at the time of admission(T0),at the time of air injection needle puncture(T1),at the time of successful pneumoperitoneum establishment(T2)and at 10 minutes after air disgassing(T3)so as to detect the levels of cortisol,epinephrine,and plasma D-lactic acid.The postoperative recovery time postoperative exhaust,defecation,borborygmus,food intake and the occurrence of postoperative complications were recorded and compared among the three groups.Results There was no statistical difference in the surgical indexes and the incidence of complications among the three groups(P>0.05).The levels of cortisol,epinephrine,and plasma D-lactic acid in three groups at T1,T2,and T3 were higher than those at T0,and the differences were statistically significant(P<0.05).The levels of cortisol,epinephrine in the high pneumoperitomeum pressure group at each time were higher than those in the other two groups with statistically significant differences(P<0.05).Among the three groups,the recovery time of gastrointestinal function in the high pneumoperitomeum pressure group was the longest(P<0.05).Conclusion Laparoscopic radical resection for rectal cancer under the CO2pneumoperitoneum pressure of 10~15 mmHg will not affect the smooth operation and postoperative recovery of gastrointestinal function.However,with the increase of pneumoperitoneum pressure,the patient′s intraoperative stress response aggravates,and the intestinal mucosal injury is more obvious.The CO2 pneumoperitoneum pressure should be controlled to 10~12 mmHg.