CAJ | 학술논문

目的：探讨腹腔镜手术不同压力CO2气腹对患者机体的IL-1β，IL-6和TNF-α的影响。方法2010年10月～2012年6月择期腹腔镜手术90例，ASAⅠ或Ⅱ级，按病例时间分为10、12、15 mm Hg组。麻醉诱导成功后，3组分别以10、12和15 mm Hg气腹压力建立CO2气腹进行手术，分别于麻醉成功后（ T0）、气腹建立后（ T1）、摆放手术体位前（ T2）、手术完毕气腹消除后（T3）、术后24 h（T4）采集外周静脉血，测定白细胞介素1β（IL-1β），白细胞介素6（IL-6）和肿瘤坏死因子α（ TNF-α）水平，以及血流动力学指标并对测定结果进行统计学分析。结果组间比较：3组患者不同时点MAP、HR、PET CO2均无统计学差异（P＞0．05）；组内比较：3组患者不同时点 MAP、HR有显著差异（P＜0．05），PETCO2无统计学差异（P＞0.05）。组间比较：3组患者T1～T3时点IL-1β、IL-6、TNF-α均有统计学差异（ P＜0．05）；组内比较：3组IL-1β在T1、T2时点与T0比较差异有统计学意义（P＜0．05），10、12 mm Hg组不同时点IL-6无统计学差异（P＞0．05），15 mm Hg组在T1、T2、T3时点IL-6显著高于T0时点（P＜0．05），12、15 mm Hg组TNF-αT1、T2、T3时点与T0比较有统计学差异（P＜0．05），10 mm Hg组仅T0与T1时点有显著差异（ P＜0．05）。结论腹腔镜手术时气腹压力较小的应激反应较轻，以10 mm Hg为宜。
목적：탐토복강경수술불동압력CO2기복대환자궤체적IL-1β，IL-6화TNF-α적영향。방법2010년10월～2012년6월택기복강경수술90례，ASAⅠ혹Ⅱ급，안병례시간분위10、12、15 mm Hg조。마취유도성공후，3조분별이10、12화15 mm Hg기복압력건립CO2기복진행수술，분별우마취성공후（ T0）、기복건립후（ T1）、파방수술체위전（ T2）、수술완필기복소제후（T3）、술후24 h（T4）채집외주정맥혈，측정백세포개소1β（IL-1β），백세포개소6（IL-6）화종류배사인자α（ TNF-α）수평，이급혈류동역학지표병대측정결과진행통계학분석。결과조간비교：3조환자불동시점MAP、HR、PET CO2균무통계학차이（P＞0．05）；조내비교：3조환자불동시점 MAP、HR유현저차이（P＜0．05），PETCO2무통계학차이（P＞0.05）。조간비교：3조환자T1～T3시점IL-1β、IL-6、TNF-α균유통계학차이（ P＜0．05）；조내비교：3조IL-1β재T1、T2시점여T0비교차이유통계학의의（P＜0．05），10、12 mm Hg조불동시점IL-6무통계학차이（P＞0．05），15 mm Hg조재T1、T2、T3시점IL-6현저고우T0시점（P＜0．05），12、15 mm Hg조TNF-αT1、T2、T3시점여T0비교유통계학차이（P＜0．05），10 mm Hg조부T0여T1시점유현저차이（ P＜0．05）。결론복강경수술시기복압력교소적응격반응교경，이10 mm Hg위의。
Objective To explore the effects of different pressures of carbon dioxide pneumoperitoneum under laparoscopic surgery on IL-1β, IL-6, and TNF-α. Methods Ninety patients with ASA Ⅰor Ⅱwho were scheduled to elective operation under laparoscopic surgery from October 2010 to June 2012 were randomly divided into three groups .After endotracheal intubation , different carbon dioxide pressures , 10 mm Hg, 12 mm Hg, and 15 mm Hg, were orderly given to group 1, 2, and 3 to build pneumoperitoneum .The serum levels of IL-1β, IL-6, and TNF-α, as well as hemodynamic parameters , were assessed at the time after anesthesia ( T0 ) , after pneumoperitoneum development ( T1 ) , of position placement before operation ( T2 ) , after dismissing pneumoperitoneum (T3), and 24 hours after operation (T4), respectively. Results The measures of MAP, HR, and PETCO2 had no significant differences between each other of the three groups ( P >0.05), and the MAP and HR results showed significant differences among the three groups at different time points (P<0.05) whereas no difference for PETCO2 values (P>0.05).There were statistical significances between the three groups in levels of IL-1β, IL-6, and TNF-αat time points of T1 , T2 , T3 , and T4 , respectively (P<0.05).As compared with T0, there were significant differences in levels of IL-1βat the time points of T1 and T2 in the three groups (P<0.05).There were no significant differences in IL-6 levels between the group 1 and group 2 at every time points (P>0.05).In the group 3, the levels of IL-6 were significantly higher at time points of T 1, T2, and T3 than at T0(P<0.05).In the group 2 and group 3, the levels of TNF-αat T1, T2, and T3 were significantly different from at T0(P<0.05), whereas in the group 1, significant difference was seen only between the time points of T 0 and T1(P<0.05). Conclusion Low pneumoperitoneum pressure leads to minor stress effects .A 10 mm Hg carbon dioxide pneumoperitoneum is recommended .