Effects Of Special Posture On Serum S100? Protein And 8-iso-PGF_2? In Patients Undergoing Gynecological Laparoscopic Surgery

Objective To observe the changes of serum S100?protein and 8-iso-PGF_2?and cerebral oxygen metabolism during operation,and to explore the effect of special posture?S?on brain and its mechanism in gynecological laparoscopic surgery.Method Forty patients?46.16±5.62,mean age+/-SD,body mass index 21.31±2.69?mean+/-SD?kg/m² and ASA grade?to??were selected who underwent elective laparoscopic gynecologic surgery.After routine induction of general anesthesia,the right internal jugular vein cannulation on all patients were applied by retrogress puncture into the jugular sinus.During operation,all patients were lie low,then changed into S position kept lean 10±2?mean+/-SD?angle and CO₂ pressure10±2(mean+/-SD mm Hg,and recovered afte pneumoperitoneum.The bloods of the jugular sinus and radial artery were collected on 30 min after anesthesia induction and before S position,60min,120min,180min,240min after S position,and 30 minutes after postures recovery and analyzed by blood gas at the same time.The internal jugular vein oxygen partial pressure,carbondioxide partial pressure,arteriovenous oxygen partial pressure,arteriovenous carbon dioxide partial pressure difference,blood lactate concentration and blood glucose concentration difference were calculated.The contents of 8-iso-PGF_2?and S100?protein in arterial blood samples were determined by Elisa at different time points.Result The operation took 291.62±24.34?mean+/-SD?min,the time of S position was 266.57±23.93?mean+/-SD?min.The levels of S100?protein and8-iso-PGF_2?in serum increased from T₂ noticeably?p<0.05?,and tended to stabilize at T₄,but they were still higher than T₀ level.T₄ Compared with T₀ and T_1,D_a-jvO₂decreased significantly?p<0.05?.D_jv-aCO₂ began significantly higher in T₂,each point compared with T0 have significant difference?p<0.05?.The time points of SjvO2 were basically stable,while the T₄ and T_E decreased,but the difference was not statistically significant?p>0.05?.The P_jvCO₂ was significantly increased at each time point from T₀ after T position?P<0.05?.Serum S100?protein was positively correlated with8-iso-PGF2 alpha at T₂,T₃ and T₄,there was no significant correlation between T₀,T₁and TE.It was found that that time point change of S100?protein and Djv-a CO2 at T2,T₃,T₄ and T_E showed a significant positive correlation and a synchronicity was present,there was no significant correlation between T0 and T1.One case of subcutaneous emphysema occurred during operation?2.50%?.Three patients had chemosis occurred?7.50%?,four cases nausea?10.00%?,two cases postoperative hypotension?5.00%?,and one case of delayed emergence from anesthesia?2.50%?postoperative follow-up 24h.All patients had no serious postoperative complications,recovered and discharged.Conclusion 1.During S position on gynecologic laparoscopic surgery,the serum S100?protein content and 8-iso-PGF2 are significantly increased,there are significantly positively correlated between 180min and 240min.It suggests that brain damage and oxidative stress exist and oxidative stress may be one of the mechanisms of brain injury during S position.2.S_jvO₂ and P_jvO₂ tend to be stable under S position,but P_jvCO₂ increases significantly.3.The D_jvO₂ is significantly less after S position,especially with the 4h.D_jv-av-a CO₂ is significantly increased after 1h,it suggest that there is a decrease in that oxygen uptake ability of the brain tissue and cerebral hyperperfusion.There is synchronicity between serum S100?and D_jv-aCO₂,in particular,has a significant positive correlation between 180min and 240min.It shows that hypercapnia is also a factor that can not be ignored in brain injury in S position.