Effect Of Different CO₂ Pneumoperitoneum Pressure To The Organism Stress In The Gynecological Laparoscopic Operation

ObjectiveTo probe the effect of different CO2 pneumoperitoneum pressure to the organism stress in the gynecological laparoscopic operation.MethodsSelect 60 patients under going laparoscopic operation which is single hysteromyoma or unilateral ovarian benign tumor, AS Aâ… -â…¡,20-50 years old, weight does not exceed 20%of normal weight,ruled out serious cardiopulmonary dieases,liver and renal function abnormal. Divided these patients randomly to three groups:high pneumopertoneum pressure group(15mmHg), middle pneumopertoneum pressure group(13mmHg), low pneumopertoneum pressure group(11mmHg). Make general anesthesia and operation,then take blood samples 1 day before surgery,30 minutes afer the surgery as well as twelve hours after surgery for determination of plasma concentration of noradrenalin(NE),cortisone(COR) and prostagland E2 (PGE2).Monitor the chang of Pet CO2,HR,SBP,DBP in the surgery.Results1.The Circulatory system:During the surgery heart rates of the three groups all rised,but the HP group increased more significantly (P<0.05),but there is no significant difference between MP and LP.30 minutes after the peumoperitoneum SBP,DBP and MAP increasd obviously (P<0.05), but there is no Significant difference between MP and LP.2.The respiratory system:Pet CO2 increased significantly 30 minutes after the peumoperitoneum,and HP>MP>LP(P<0.05). 3.The neuro-endocrine system:The three groups showed no difference in the content of the hormone.PGE2 increased obviously during the operation and still beyond the normal level 12 hours after the surgery, HP>MP>LP(P<0.05).NE rised significantly during the surgery,comparision among the groups shows that:the content of NE in LP increased significantly (P<0.05), but there is no significant difference between MP and LP.12 hours after the surgery, comparision among the groups shows that:the variation trend of NE as same as intraoperation..COR rised significantly during the surgery,comparision among the groups shows that:the content of COR in LP increased significantly (P<0.05), but there is no significant difference between MP and LP.12 hours after the surgery, comparision among the groups shows that:the variation trend of COR as same as intraoperation.ConclusionSince the invention of laparoscopic technique,it experiences from diagnosis to therapy, from completing a simple surgical operation to the completion of the enormous complexity.Its applications are becoming increasingly widespread. Pneumoperitoneum is one of the most important prerequisites for the surgery.At present CO2 has became the most popular media of insufflations, but it can cause intraobdominal hypertention and hypercapnia, even can cause the chang of the circulatory system, the respiratory system, the nervous as well as the endocrine system.There is the posbility of respiratory allcalosis, myocardial ischemia,myocardial infarction and arrhy thmia in the surgry. The experimental data showed pneumoperitoneum pressure increases, meanwhile the stress elevats, there is correlation between them. Therefore, It can sustain life signs and neuroendocrine stability by reducing the intra-abdominal pressure during laparoscopic surgery.we must pay attention to the blood pressure,blood suger before the surgery,and monitor the blood pressure,rhythm of the heart,ECG in the opration. In condition of enough oprating space,the LAP should be decreased in order to avoid the complications of the surgery.In patients with poor Cardiopulmonary function, the advantages of low IAP are more obviously. As long as anesthesiologist cooperate closely with the highly skilled surgeon, we can also obtain good muscle relaxation, low pressure of laparoscopic surgery not only obtain good vision,but also don't affect the surgical operation and extend the operation time.