Sutton Elie, Bellini Geoffrey, Grieco Michael J, Kumara H M C Shantha, Yan Xiaohong, Cekic Vesna, Njoh Linda, Whelan Richard L
1 Mount Sinai West Hospital Center, New York, NY, USA.
2 Maimonides Medical Center, Brooklyn, NY, USA.
Surg Innov. 2017 Oct;24(5):471-482. doi: 10.1177/1553350617715834. Epub 2017 Jun 27.
Peritoneal insufflation with warm-humidified (WH) CO gas during minimally invasive surgical procedures is purported to prevent hypothermia and peritoneal desiccation and is associated with decreased postoperative IL-6 levels. This randomized study's purpose was to determine the clinical impact of WH versus cold-dry (CD) CO in minimally invasive colon resection (MICR), and to assess perioperative plasma levels of IL-6, TIMP-1, sVEGF-R1, and HSP-70 after MICR.
Operative and short-term clinical data plus perioperative blood samples were collected on MICR patients randomized to receive either WH (36.7°C, 95% humidity) or CD (room temperature, 0% humidity) CO perioperatively. Peritoneal biopsies were taken at the start and end of surgery. Outcomes tracked included core temperature, postoperative in-hospital pain levels, analgesia requirements, and standard recovery parameters. Preoperative and postoperative days (PODs) 1 and 3 plasma protein levels were determined via ELISA.
A total of 101 patients were randomized to WH CO (50) or CD CO (51). The WH group contained more diabetics ( P = .03). There were no differences in indication, minimally invasive surgical method used, or core temperature. Pain scores were similar; however, the WH patients required less narcotics on PODs 1 to 3 ( P < .05), and less ketorolac on PODs 1 and 2 ( P < .03). No differences in length of stay, complication rates, or time to flatus/diet tolerance were noted. Plasma levels of the 4 proteins were similar postoperatively. Though insignificant, the WH group had less marked histologic changes on "end-of-case" peritoneal biopsies.
This study found significantly lower pain medication requirements for PODs 1 to 3 for the WH group; however, because there were no differences in the pains scores between the groups, firm conclusions regarding WH CO cannot be made.
在微创手术过程中，用温湿（WH）二氧化碳气体进行腹膜充气据称可预防体温过低和腹膜干燥，并与术后白细胞介素-6水平降低有关。这项随机研究的目的是确定温湿二氧化碳与冷干（CD）二氧化碳在微创结肠切除术（MICR）中的临床影响，并评估微创结肠切除术后白细胞介素-6、基质金属蛋白酶组织抑制因子-1（TIMP-1）、可溶性血管内皮生长因子受体-1（sVEGF-R1）和热休克蛋白-70（HSP-70）的围手术期血浆水平。
收集接受围手术期WH（36.7°C，95%湿度）或CD（室温，0%湿度）二氧化碳的微创结肠切除术患者的手术和短期临床数据以及围手术期血样。在手术开始和结束时进行腹膜活检。跟踪的结果包括核心体温、术后住院疼痛水平、镇痛需求和标准恢复参数。术前和术后第1天及第3天的血浆蛋白水平通过酶联免疫吸附测定法（ELISA）测定。
共有101例患者被随机分为WH二氧化碳组（50例）或CD二氧化碳组（51例）。WH组糖尿病患者更多（P = 0.03）。在手术指征、所采用的微创手术方法或核心体温方面没有差异。疼痛评分相似；然而，WH组患者在术后第1至3天所需的麻醉剂较少（P < 0.05），在术后第1天和第2天所需的酮咯酸较少（P < 0.03）。在住院时间、并发症发生率或排气/饮食耐受时间方面没有差异。术后4种蛋白质的血浆水平相似。虽然不显著，但WH组在“手术结束时”的腹膜活检中组织学变化较小。
本研究发现WH组在术后第1至3天的止痛药物需求显著较低；然而，由于两组之间疼痛评分没有差异，因此无法就温湿二氧化碳得出确凿结论。
