Effect Of Pneumoperitoneum On Serum Citrulline,Intestinal Fatty Acid Binding Protein And Gastrointestinal Mucosal Tension Index In Patients With Gynecological Laparoscopic Surgery

Objective To observe the changes of serum citrulline,human intestinal fatty acid binding protein?I-FABP?concentration and gastric mucosal tension during surgery dynamically,and to explore the influence and its mechanism of pneumoperitoneum duration on gastrointestinal mucosa in patients undergoing gynecologic laparoscopic surgery.Methods Forty patients undergoing elective gynecologic laparoscopic surgery.After the conventional inhalation combined anesthesia method was used to induce tracheal intubation,the stomach tension was monitored through the nose to the stomach cavity.Intraoperative line 11mmHg CO₂ pneumoperitoneum.The heart rate,mean arterial pressure,saturation of pulse oxygen,partial pressure of end tidal carbon dioxide,and pressure of gastric mucosal carbon dioxide?PgCO2?were recorded pre-pneumoperitoneum?T0?,pneumoperitoneum 60min?T1?,pneumoperitoneum120min?T2?,pneumoperitoneum 180min?T3?,pneumoperitoneum 240min?T3?,and post-pneumoperitoneum ending 30min?TE?points.The partial pressure of astric mucosal-arterial blood carbon dioxide difference?Pg-aCO₂?and intra-mucosal pH?pHi?,and arterial blood gas analysis,serum I-FABP,and citrulline concentration were collected from the radial arterial blood and analyzed these clinical indicators changes of patients at different time points.Results The pneumoperitoneum time in patients was 265.7±28.79 minutes.The vital signs were stable and all patients were discharged after cured.1.pHi decreased with prolonged time of pneumoperitoneum,and T2 was the lowest,which followed by a relatively stable time?p<0.05?.Although recovered partial at TE,however,it was still lower than T1?p<0.05?.2.Pg-aCO₂ was significantly increased from the beginning of T1 with prolongation of the pneumoperitoneum?p<0.01?,and reached the highest level at T₂point,there was no significant difference between T2,T3,and T4?p>0.05?.And the level of Pg-aCO₂ at TE was still higher than T0?p<0.05?.3.Serum I-FABP level increased after pneumoperitoneum gradually,and there was a significant difference?p<0.05?between T0 and each time point else.The expression level of I-FABP reached the highest at T2,which was different from T1?p<0.05?;T2 to T4 were relatively stable?p>0.05?;The Serum I-FABP level at TE was still higher than T0?p<0.05?.4.The level of serum citrulline decreased with prolonged pneumoperitoneum duration,especially the point of T1 and TE,being the most significant;these were significantly different beteween T1 and T0,TE and T4 which have statistical significance?p<0.05?;however,T2 and T3 showed no difference statistical significance?p>0.05?.5.There was a positive correlation between Pg-aCO₂ and serum IFABP at T1,T2and T3?r=0.59,r=0.80 and r=0.92,p<0.05?.Morever,at T1 and T2,the level of Pg-aCO₂ were negatively correlated with serum citrulline?r=-0.53,r=-0.42,p<0.05?.Conclusion1.In the gynecologic laparoscopic surgery,the serum I-FABP concentration increases with the time of pneumoperitoneum,which reaches the highest point at 120 min.Citrulline decreases with prolonged pneumoperitoneum duration,especially in the pneumoperitoneum 60min.At post-pneumoperitoneum ending 30 minutes,both indicators were different from those pre-pneumoperitoneum,which implicited the presence of gastrointestinal mucosal injury during pneumoperitoneum,and it was related to the duration of pneumoperitoneum,most importantly,it was difficult to recover shortly after pneumoperitoneum2.During gynecologic laparoscopic surgery,pHi decreased with increased pneumoperitoneum duration,with the lowest 120 minutes after pneumoperitoneum,and Pg-aCO₂ increased significantly with prolonged pneumoperitoneum duration,especially at point of 120 min after pneumoperitoneum,and post-pneumoperitoneum ending 30 minutes.None of the indicators recovered to pre-pneumoperitoneal levels.It is suggested that these are gastro-intestinal mucosal acidosis and gastrointestinal hypoperfusion during pneumoperitoneum and that it does not recover shortly after pneumoperitoneum.3.There was a positive correlation between Pg-aCO₂ and I-FABP at point after pneumoperitoneum 60min,120min,180min;the level of Pg-aCO₂ were negatively correlated with serum citrulline at pneumoperitoneum 60min,120min.It is suggested that hypoperfusion in the gastrointestinal tract of the pneumoperitoneum is one of the causes of gastrointestinal mucosal damage,and the severity of the injury was also related to the pneumoperitoneum duration.