Li Sheng-Hua, Deng Juan, Huang Fa-Tian, Gan Xiao-We, Cao Yun-Gui
Department of Anesthesiology, Maternal and Child Health Hospital 1216 Gao Tai Road, Jiading District, Shanghai 201821, China.
Department of Gynecology, Maternal and Child Health Hospital 1216 Gao Tai Road, Jiading District, Shanghai 201821, China.
Int J Clin Exp Med. 2014 Sep 15;7(9):2877-82. eCollection 2014.
This study aimed to explore the impact of gasless laparoscopy on circulation, respiration, stress response and other complications in gynecological surgery for old female patients. 40 patients (American Society of Anesthesiologists II-III, 60-70y) scheduled for elective gynecological laparoscopy were divided into non-pneumoperitoneum group (NP) and pneumoperitoneum group (P). All patients included were monitored for Compliance, Ppeak, Ppalt, MAP, CVP, HR, SpO2, blood gas analysis (pH, PaCO2, and PaO2), serum cortisol, TNF-α, and IL-6. There were significant differences in bowel tones recovery, postoperative shoulder pain, nausea, and vomiting between two groups (P < 0.05). In the P group, the levels of CVP, and Ppeak and Ppalt at both 10 minutes and 30 minutes after suspension/pneumoperitoneum were significantly higher than those in NP group (P < 0.05). When it came to Compliance, this trend was reversed (P < 0.05). As surgery was conducted, the plasma concentrations of cortisol, IL-6 and TNF-α in the P group were higher than those in the NP group (P < 0.05). Thus, for gynecological diseases of geriatrics, the effect on respiratory and circulatory function is less significant of gasless laparoscopy than in pneumoperitoneum. The stress response, recovery of bowl tone, should pain, nausea, and vomiting after surgery in gasless laparoscopy is improved than in pneumoperitoneum.
本研究旨在探讨免气腹腹腔镜手术对老年女性患者妇科手术中循环、呼吸、应激反应及其他并发症的影响。将40例计划行择期妇科腹腔镜手术的患者（美国麻醉医师协会分级II - III级，年龄60 - 70岁）分为非气腹组（NP）和气腹组（P）。对所有纳入患者监测顺应性、峰压、平台压、平均动脉压、中心静脉压、心率、脉搏血氧饱和度、血气分析（pH值、动脉血二氧化碳分压和动脉血氧分压）、血清皮质醇、肿瘤坏死因子-α和白细胞介素-6。两组在肠鸣音恢复、术后肩痛、恶心和呕吐方面存在显著差异（P < 0.05）。在P组中，气腹/放气后10分钟和30分钟时的中心静脉压、峰压和平台压水平均显著高于NP组（P < 0.05）。而顺应性方面则相反（P < 0.05）。随着手术进行，P组血浆皮质醇、白细胞介素-6和肿瘤坏死因子-α浓度高于NP组（P < 0.05）。因此，对于老年妇科疾病，免气腹腹腔镜手术对呼吸和循环功能的影响较气腹腹腔镜手术小。免气腹腹腔镜手术术后的应激反应、肠鸣音恢复、肩痛、恶心和呕吐情况较气腹腹腔镜手术有所改善。
