Department of Surgery, South Auckland Clinical School, University of Auckland, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
Ann Surg. 2010 Jun;251(6):1024-33. doi: 10.1097/SLA.0b013e3181d77a25.
We aimed to test the hypothesis that warming and humidification of insufflation CO2 would lead to reduced postoperative pain and improved recovery by reducing peritoneal inflammation in laparoscopic colonic surgery.
Warming and humidification of insufflation gas is thought be beneficial in laparoscopic surgery, but evidence in prolonged laparoscopic procedures is lacking.
We used a multicenter, double-blinded, randomized controlled design. The Study Group received warmed (37 degrees C), humidified (98% RH) insufflation carbon dioxide, and the Control Group received standard gas (19 degrees C, 0% RH). Anesthesia and analgesia were standardized. Intraoperative oesophageal temperature was measured at 15 minutes intervals. At the conclusion of surgery, the primary surgeon was asked to rate camera fogging on a Likert scale. Postoperative opiate usage was determined using Morphine Equivalent Daily Dose (MEDD), and pain was measured using visual analogue scores. Peritoneal and plasma cytokine concentrations were measured at 20 hours postoperatively. Postoperative recovery was measured using defined discharge and complication criteria, and the Surgical Recovery Score.
Eighty-two patients were randomized, with 41 in each arm. Groups were well matched at baseline. Intraoperative core temperature was similar in both groups. Median camera fogging score was significantly worse in the Study group (4 vs. 2, P = 0.040). There were marginal differences in pain scores, but no significant differences were detected in MEDD usage, cytokine concentrations, or any recovery parameters measured.
Warming and humidification of insufflation CO2 does not attenuate the early inflammatory cytokine response, and confers no clinically significant benefit in laparoscopic colonic surgery.
我们旨在检验以下假设，即通过减少腹腔镜结肠手术中的腹膜炎症，使二氧化碳注入气体加热和加湿可减轻术后疼痛并促进恢复。
人们认为，在腹腔镜手术中对注气进行加热和加湿是有益的，但缺乏对长时间腹腔镜手术的证据。
我们采用了多中心、双盲、随机对照设计。研究组接受了加热（37°C）、加湿（98% RH）的二氧化碳注入气体，对照组接受了标准气体（19°C，0% RH）。麻醉和镇痛均标准化。术中每隔 15 分钟测量食管温度。手术结束时，主刀医生会根据李克特量表评估摄像镜头起雾的情况。术后阿片类药物的使用量通过吗啡等效日剂量（MEDD）来确定，疼痛通过视觉模拟评分来衡量。术后 20 小时测量腹膜和血浆细胞因子浓度。使用明确的出院和并发症标准以及手术恢复评分来衡量术后恢复情况。
82 例患者被随机分组，每组 41 例。两组在基线时匹配良好。两组的核心体温在术中相似。研究组的摄像镜头起雾评分中位数明显更差（4 分与 2 分，P = 0.040）。疼痛评分存在差异，但在 MEDD 使用量、细胞因子浓度或任何测量的恢复参数方面未发现显著差异。
二氧化碳注入气体的加热和加湿并不能减轻早期炎症细胞因子反应，在腹腔镜结肠手术中也没有带来明显的临床获益。
