The Change Of P_ETCO₂ Of Gynecologic Laparoscopic And Open Surgery And The Effects On Myocardial Enzymogram And The Stress Response

Objective:To study the effects of Gynecologic laparoscopic and open surgery on P_ETCO₂ and myocardial enzymogram and the stress response and Blood glucose(GLu).Methods:40 cases of ASAⅠ～Ⅱpatients undergoing Gynecologic were randomly divided into two groups of 20:group A received Gynecologic laparoscopic and group B received open surgery The P_ETCO₂ HR and MAP of all patients were recorded before induction, 5,10,15,30 minutes after insufflation or abdominal incision,and 15,30 minutes after the release from pneumoperitoneum or operation.Serum ereatine kinase(CK) CK myocardial isoforms(CK-MB),asparatate anlinotransferase(AST) and lactate dehydrogenase(LDH) concentrations were measured before operation and at 24th hours after operation.Serum cortisol were measured before operation,at the 20 minutes after incision,at the end of operation,at the 10th and 24th hour after operation.GLu were measured before operation,at 1 day end of operation,at 2 day end of operation.Results:(1) In group A,in comparison with 5 minutes before induction,patients' P_ETCO₂ were increased 10 minutes after insufflation(P＜0.05),While 15 minutes later P_ETCO₂ were significantly increased(P＜0.01).Patients' P_ETCO₂ in group A were remarkably increased at 15 minutes after the release from insufflation compared to 5 minutes before induction(P＜0.01),while they fell to normal range at 30 minutes after insufflation(P＞0.05).P_ETCO₂ in group A were markedly increased in comparison with group B during operating time(P＜0.01) and after release from insufflation or operation(P＜0.01).(2) Serum CK and AST concentrations at the 24th hour after operation were significantly more than those before operation in Agroup(P＜0.05).Serum LDH concentration after operation was obviously more than that before operation in B group(P＜0.05).(3) Serum cortisol concentrations at the end of operation and at the 10th hour after operationwas higher than that before operation in B group(P＜0.05).At every time points but before operation,serum cortisol concentrations were more in B group than those in A group,all patients' GLu were insignificantly(P＞0.05) before induction,all patients' GLu were significantly(P＜0.05) after operation.(4) In group A patients' HR MAP were increased after insufflation(P＜0.05).Conclusion:(1) During the anesthesia time of laparoscopic P_ETCO₂ were obviously increased 10 minutes after intra-abdominalCO₂ insufflation and reached the peak at 20 minutes. P_ETCO₂ decreased to normal range 30 minutes after release from insufflation.(2) Laparoscopic operation may lead to the potential myocardial damage.