A Clinical Studies Of The Effects Of CO₂ Pneumoperitoneum On The Concentration Of Gastrin And Motilin In Laparoscopic Surgery

Objective:Laparoscopic surgery is often associated with a high incidenceof postoperative nausea and vomiting. The reason, one is operative procedureand stimulated internal organ during the operation. the other is carbon dioxidepneumoperitoneum which often be considered the importanted factor. But thespecifical mechanism is still not explanation. gut hormone is the significanceneuromediator in pathogenesy of nausea and vomiting. There was a strongrelationship between variability of gut hormone and nausea and vomiting. Thisinvestigation, through determine the concentration of plasma motilin and gastrinin different given time. To approach the reason of nausea and vomiting effectedby CO2 pneumoperitoneum during laparoscopic surgery .Method: Twenty ASAI-II patients undergoing elective cholecystectomywere randomly devided into two groups under general anaesthesia, laparoscopiccholecystectomy (LC)and open cholecystectomy(OC), group LC as a studygroup and group OC as a control group. A standard anaesthesic was giveninvolving induction,intubation and mechanicl ventilation. Anaesthesia wasmaintained with fentanil, vecuronium bromide and 1﹪-2﹪isoflurane.Bloodsamples were taken before operation(T1), 10 min after CO2 pneumoperitoneum(T2), 25 min after CO2 pneumoperitoneum (T3) and 15 min after deflation (T4)in group LC;before operation(T1), open peritonaeum(T2), after removedgallbladder (T3) and after operation (T4) in group OC. The concentration ofplasma motilin and gastrin was measured , the incidence of postoperative nauseaand vomiting was observed.Result : The first, the change of motilin level in two group: Thepreoperative level of motilin was similar in both groups ( P > 0.05);At T2, Theconcentration of plasma motilin increased in both groups compared with thepreoperative level , it had no significant difference(P>0.05), but the plasmamotilin level increased obviously in group LC compared with group OC;plasmamotilin concentration at T3 and T4 increased significant compared with thepreoperative data in group LC(P<0.05);The concentration of plasma motilin atT4 was lower than that at T3 in Group LC, but it had no significant difference( P>0.05);The concentration of plasma motilin at T4 increased significantcompared with the preoperative level in group OC(P<0.05);concentration ofplasma motilin in Group LC was much higher than that in group OC at T3 and T4( P<0.05).The second, the change of gastrin level in two group: The preoperativelevel of gastrin was similar in both groups ( P > 0. 05);At T2, The concentrationof plasma gastrin increased in both groups compared with the preoperative level ,but it had no significant difference( P>0. 05);plasma gastrin concentration atT3 and T4 increased significant compared with the preoperative data in group LC((P<0.001) and (P<0.05);the concentration of plasma motilin in Group LCwas much higher than that in group OC at T3 and T4( P<0.05).The third, The incidence of postoperative nausea and vomiting was muchhigher in Group LC than that in group OC during the first 12hpostoperatively( P<0. 05).Conclusions: This investigation through determine the concentration ofplasma motilin and gastrin in different given time in laparoscopiccholecystectomy and open cholecystectomy. The result suggest that CO2pneumoperitoneum during laparoscopic surgery may increase the level ofplasma gastrin and gastrin concentration. which may be one of the mechanismsbehind the higher incidence of postoperative nausea and vomiting associatedwith CO2 pneumoperitoneum.