妇科腹腔镜手术与开腹手术对心肌酶谱及神经内分泌激素的影响

目的:比较腹腔镜妇科手术及开腹手术对病人心肌酶谱及神经内分泌激素的影响。方法:40例ASAⅠ~Ⅱ级,年龄27~55岁,在硬外麻下择期行妇科手术的病人,按手术方式不同分为两组。L组(n=20),在腹腔镜下手术;O组(n=20),行开腹手术。两组均于手术开始前、术后第1天早晨7时抽左肘静脉血3ml,检查血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)。另于术前、手术开始后20min、术毕和术后10h、24h采集血样,应用放免法测血清皮质醇、胰岛素和T3、T4、TSH的水平。结果:(1)L组CK、AST术后24h均明显高于术前(P<0·01),O组除LDH术后高于术前外(P<0·01),其他指标均无明显差异;(2)两组术前和术后24h测定的各项内分泌激素无显著差异(P>0·05)。L组皮质醇于术毕明显增高,但与手术前比较,无统计学差异(P>0·05)。两组胰岛素的变化均无显著差异(P>0·05)。O组皮质醇术毕及术后10h较手术前明显升高(P<0·05);O组皮质醇除术前外均显著高于L组相同时点值(P<0·05)。O组胰岛素术后10h明显高于手术前水平(P<0·05)。两组围术期T3、T4和TSH均无明显变化。结论:腹腔镜手术CO2气腹对心肌酶的影响较开腹手术大,但应激反应小于开腹手术。

Effects of laparoscopic and conventional gynecological operation on myocardial enzymogram and neuroendocrine hormone

Objective:To compare the effects of laparo sc opy and conventional gynecological operation on myocardial enzymogram and neuroe ndocrine hormone of patients. Methods:40 cases of ASA Ⅰ～Ⅱpatients, aged 27～55,under went elective gynecological operation under epidural anaesthesia,were divided t wo groups according to the operative way: L group received laparoscopic operatio n and O group underwent open abdominal operation. Serum creatine kinase (CK), C K myocardial isoforms (CKMB),asparatate aminotransferase (AST) and lactate dehy drogenase (LDH) concentrations were measured before operation and at 24th hours after operation. Serum cortisol, insulin, T3, T4 and thyroid stimulating hormon e (TSH) concentrations were measured before operation,at the 20 minutes after i ncision,at the end of operation,at the 10th and 24th hour after operation. Results:Serum CK and AST concentrations at the 24th hour a fter operation were significantly more than those before operation in L group ( P<0.05). Serum LDH concentration after operation was obviously more than that before operation in O group (P<0.05). Serum cortisol concentrations at the end of operation and at the 10th hour after operation was higher than tha t before operation in O group (P<0.05). At every time points but before o peration,serum cortisol concentrations were more in O group than those in L gro up. In O group,serum insulin level at the 10th hour after operation was signif icantly more than that before operation (P<0.05). Conclusion:Laparoscopic operation may lead to the potentia l myocardial damage.