Clinical Study On The Prevention And Treatment Of Abdominal Organ Ischemia Reperfusion Injury During Long Term Laparoscopic Surgery

Background:In recent years,laparoscopic surgery has been widely used in the world.Laparoscopic surgery has several advantages like small injury,fast recovery and so on,which have greatly reduced the pain of patients.However,it is also found that,after laparoscopic surgery,the patient's internal organs often changed.It is particularly significant for those who are suffering from serious organ disease.The reason is related to ischemia reperfusion injury induced by CO2 pneumoperitoneum during operation.Many scholars have paid close attention to IRI related research,and have made some progress.They found that a variety of drugs or preconditioning may have a protective effect on the body damage after IRI,such as Propofol,Dexmedetomidine(DEX),high perfusion and ischemic preconditioning(IPC).However,most of these results are limited to animal experiments,and there is no evidence to support the safety and efficacy of clinical application.All the patients and their families have signed the consent form.The research has been approved by the medical ethics committee of the Shenyang Military District General Hospital.The purpose of this study is to investigate the effect of long term laparoscopic surgery on ischemia reperfusion injury of abdominal viscera through two clinical studies.And we will investigate the effects of dexmedetomidine pretreatment and remote ischemic preconditioning on the prevention and treatment of abdominal organ ischemia reperfusion injury,in order to provide clinical evidence for the prevention and treatment of abdominal organ ischemia reperfusion injury during long term laparoscopic surgery.Objective:(1)It is our objective to investigate the effects of long term laparoscopic surgery on abdominal viscera ischemia / reperfusion injury.(2)It is our objective to investigate the preventive and therapeutic effects of dexmedetomidine preconditioning and remote ischemic preconditioning on the abdominal organ ischemia / reperfusion injury induced by prolonged laparoscopic surgery.Methods:(1)Part 1: A clinical study of abdominal organ ischemia reperfusion injury in patients undergoing long term laparoscopic surgeryA total of 30 patients with rectal cancer who underwent radical resection of colorectal cancer in our hospital were selected as the subjects of this study.In T1-T5 time points 5ml of venous blood was collected for the detection of ALT,AST,PDL,DAL,MDA,SOD,TNF-? and IL-6 to observe and compare the changes of the above indexes in different times.(2)Part 2: A clinical study on the preventive and therapeutic effects of DEX preconditioning and RIPC on ischemia reperfusion injury induced by prolonged laparoscopic surgeryThe second part of the study was a randomized,controlled,double-blind clinical study.A total of 140 patients with rectal cancer who underwent radical resection of colorectal cancer in our hospital were selected as the subjects of this study.The patients were divided into four different groups.The patients in different groups received different treatments.The DEX group was given DEX intravenous injection treatment,RIPC group received RIPC pretreatment,DEX+RIPC group was given DEX and RIPC combined treatment,and the control group was given intravenous infusion of normal saline.In T1-T5 time points 5ml of venous blood was collected for the detection of ALT,AST,PDL,DAL,TNF-? and IL-6 to observe and compare the changes of the above indexes in different times.The days of hospitalization,complications,postoperative exhaust time and postoperative defecation time were observed and recorded after the operation.Results:(1)Part 1: 1.After deflation,ALT and AST levels increased to T2 and reached the peak level,and then showed a downward trend;2.PDL index rose to T2 and reached a peak value,then showed a downward trend;The DAO index rose to T4 and reached a peak value,then showed a downward trend;3.No significant changes were found in the indexes of oxidative stress;4.The inflammatory response index increased to T4,and then decreased.(2)Part 2: The levels of ALT,AST,PDL,DAO,TNF-? and IL-6 of the DEX,RIPC,and DEX+RIPC groups were all reduced by T2-T4.The DEX+RIPC group as a combined treatment group has the lowest level of the indicators.The DEX+RIPC group has the lowest hospitalization,postoperative exhaust time and postoperative defecation time.Conclusion:(1)Long term laparoscopic surgery can cause liver and intestinal ischemia and reperfusion injury.(2)The application of DEX preconditioning or RIPC can prevent and treat the ischemia reperfusion injury of abdominal viscera caused by prolonged laparoscopic surgery.And it is better to implement both DEX and RIPC.