The Influence Of Compound Incubation To The Patients' Stress Reaction In Laparoscopic Operation

Background:laparoscopic operation is micro-trauma, but it still stimulate body'stress reaction system, and co2 aeroperitonia is also a strong stress to the body, inducing the increasing of intraabdominal pressure and hypercapnia, which induce the increasing of body'stress reaction and significant variation of haemodynamics. At the same time, hypothermy in the operation is an usual phenomenon, which will induce negtive stress and bad results .some study indicate that there are 50%-70% patients will be hypothermy during the operations.recently, more and more doctors realize the hypothermy is very harmful to patients during surgery opertion, so keep temperature constantly can reduce the harmful stress reaction and keep haemodynamics stably, so select a suitable method to prevent hypothermy is very important to surgery patients.Now, warming transfusion and incubating blankets, etc have been using separately in normal abdominal operation, organ transplanation operation, neur osurgery operation and so on to prevent hypothermy.although using one method can prevent hypothermy, it can't avoid other factors'influence.compound incubation use some method to keep temperature congstantly, prevent hypothe rmy and keep normal physiologic functions, which including keeping suitable room temperatur(e22℃-24℃), humidity(40%-60%), four limbs and trunk covered by woolen blankets, circulation water blankets under body(37℃-40℃),and keep intravenous transfusions and douche at 37℃in order to keep the patients'temperature stable, avoiding the drop of temperature to safeguard the normal physiological function.As a natural, non-wound therapy, compound incubation makes patients feel comfortable during operation, and keep temperature constantly, prevent hypothe rmy, lighten stress reation, hold haemodynamics, so that, it can help patients safely through surround operation period.but, there is few study on compound incubation in laparoscopic operation .Purpose:In our study, we research the following items'changes surround operation period, adnephrin(AD), norepinephrine(NE) in plasma, systolic bloo d pressure(SBp), diastolic blood pressure(DBp), heart rate and prothromb in time(PT), actived partial thromboplastin time(APTT) and fibrinogen(FBG), to estimate the influence of compound incubation to the patients'stress reaction during the laparoscopic operation.so that we can obtain a safe, conveniece, reliability and effective therapy to keep patients'temperature stably to help patients undergoing surgery safely.Method:choose non-emergency laparoscopic cholecystectomy(LC) 40 patients, ASA I-II, age from 20 to 65 years old, body weight between 50KG and 80KG, without diseases of heart, lung, liver, kidney and psycho-neuro diseases.they are divided into two groups randomly, A and B.A group is in compound incubation(experimental group) and B group is in normal incubatio n(control group), each have 20 patients. keep suitable room temperatur e(22℃-24℃), humidity(40%-60%)and four limbs and trunk covered by wool en blankets in all groups. In group B(CG), we use normal intravenous transfu sions and douche; Iin group A(EG), we use circulation water blankets under patients'body(37℃-40℃),and keep intravenous transfusions and douche at 37℃.Patients are given atropine 0.5 mg,im, 30 minutes before operation, when they reach operating roon, begin intravenous transfusions : natrium lacticum and 6% middle molecular hydroxyethyl starch, which transfused rate is 2:1, after normal anesthetic induction, tracheal intubation and contact multi-functi onal anesthetic machine with intermittent positive-pressure ventilation (IPPV), tidal volume(VT) is 10ml/kg, breathing rate(BR) is 14/min.we use propofol targ et controlled infusion to maintain anesthesia till closing the abdomen. The pres sure of pneumoperitoneum is 12mmHg or 13mmHg.We record the two groups separately such datas:temperature of epipharynx, SBp and DBp on these time s:the entering room time(after entering 10 minutes), 10 minutes before pneum operitoneum, 10 minutes after pneumoperitoneum, the finishing time of operati on(without pneumoperitoneum 5 minutes) and 3 hours after operation; and we collect centrifuged supernatant of venous blood from non-tr ansfusion limbs, after entering 10 minutes, the finishing time of operatio n 5ml and 10 minutes before pneumoperitoneum, 10 minutes after pneum operiton eum 2ml, using radioim- munity to measure the contents of AD and NE; and we use the left 3ml blood from the after entering 10 minutes, the finishing time of operation 5mlto test PT APTT and FBG in chemical examination departm ent.Result:①The patients in the two groups are non-statistic difference in age, sex, body weight, the time of pneumoperitoneum, the volume of transfusion and douche, and room temperature(P>0.05), and there are comparability between the two groups②after operation, the patients in group A have shorter palinesthesia-time and less shakes than that in groep B, and there are obvious statistic difference on these(P<0.05).③there are non-statistic difference(P>0.05)in the two groups'temperature of epipharynx at the entering room time, the patients in group A change little at others time points(P>0.05).but the temperature of epipharynx of the patients in group B decrease obviously at the time"10 minutes after pneumoperitoneum", and there are obvious statistic difference at these points: 10 minutes after pneumop eritoneum, the finishing time of operation and 3 hours after operation with the entering room time(P<0.01).and the other points are not(P>0.05).the temperature of the patients in group A are obviously higher than that in group B at these points: 10 minutes after pneumoperitoneum, the finishing time of operation and after operation(P<0.01).④there are non-statistic difference in the ertering time'SBp, DBp and HR between the two groups(P>0.05).the changes in group A are few, but their SBp, DBp and HR are become higher after pneumoperitoneum(P<0.05),and the SBp, DBp do not become normal level to entering's(P<0.05),there are non-statistic difference in the HR between the two points:after operation and entering time(P>0.05).there are non-statistic difference between other points and entering time(P>0.05).The changes in group B are great, there are obvious statistic difference in SBp, DBp and HR between the points after pneumoperitoneum, after operation and entering time(P<0.01),also the HR between the after operation time and the entering time(P<0.01),and others time points are non-statistic.each item at the two points: after pneumoperitoneum time and after operation time in group B are much higher than that in group A(P<0.05),and the HR in the two groups at after operation time are obviously different(P<0.05)⑤there are no obvious difference between the two groups of the concentration of AD before operation(P>0.05),and both of which are getting riseing obviously after pneum operitoneum(P<0.01 ),and do not return to the level of preoperation(P<0.01).at these two points: after pneumoperitoneum time and after operation time, the elevated extents in group A are less than that in group B, and there are obviously different between the two groups(P<0.01). there are no obvious difference between the two groups of the concentration of NE before operation(P>0.05),and both of which are higher obviously after pneumope ritoneum than that befre operation(P<0.01),but they nearly become normal after operation(P>0.05).compareing within the NE after pneumo peritoneum two groups of NE after pneumoperitoneum, group A is less obviously than group B(P<0.01),there are no obvious difference between the two groups(P>0.05).⑥.the PT, APTT, FBG before operation in the two groups are non-different(P>0.05),which prolong after operation.but the changes in group A are less than that in group B, there are non-obvious difference in group A(P>0.05),but that in group B is different compared with group A(P<0.05),and there are obvious difference between the two groups(P<0.05).Conclusion:Using compound incubaion, we can't inhibit completely the stress reaction causing by surgery of the patients during the surround operation period, but it can keep the temperature constantly during the surgery, avoiding the occurrence of hypothermia, soothing the adverse reaction from the excitati on of part of adrenergic nerve to partly lighten the stress reaction during the operation, hold haemodynamics stably, avoiding the various complications of hypothermia to guarantee the regulation of normal physiologic function, so that we can make patients complete the operation safely.