目的探讨后腹腔镜手术下CO2气腹对老年患者局部脑氧饱和度(rScO2)及S-100β蛋白的影响。方法纳入2018年5月至2019年3月择期行后腹腔镜下根治性肾切除术的老年患者55例。术中气腹压为15 mm Hg,通过应用FORE-SIGHT近红外无创脑氧检测仪监...目的探讨后腹腔镜手术下CO2气腹对老年患者局部脑氧饱和度(rScO2)及S-100β蛋白的影响。方法纳入2018年5月至2019年3月择期行后腹腔镜下根治性肾切除术的老年患者55例。术中气腹压为15 mm Hg,通过应用FORE-SIGHT近红外无创脑氧检测仪监测rScO2。分别记录:T0(入室即刻)、T1(气腹前5 min)、T2(CO2气腹后10 min)、T3(CO2气腹后30 min)、T4(CO2气腹后60 min)、T5(关闭CO2气腹后10 min)各时点即刻的脉搏氧饱和度(SpO2)、心率(HR)、脑血氧饱和度(rScO2)和平均动脉压(MAP)。检测并记录T0~T5即刻的血气pH、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血红蛋白(Hb)等数据;检测T0与T4即刻的颈内静脉血浆S-100β蛋白水平。结果S-100β蛋白、rScO2、PaCO2、pH和PaO2在T0至T56个时相间差异均有统计学意义(P均<0.01),MAP、HR、SpO2和Hb在T0至T56个时相间差异均无统计学意义(P均>0.05)。两两时相间差异显示,与T0比较,T4~T5时的rScO2明显增高,T4时的S-100β蛋白水平明显增高;与T0~T1相比,T3~T5时的pH明显降低,T2~T5的PaCO2明显增高,差异均有统计学意义(P均<0.05)。结论后腹腔镜下CO2气腹可使老年患者rScO2明显增高;且颈内静脉血S-100β蛋白水平及动脉血PaCO2随CO2气腹时间的延长而逐渐增高。展开更多
Object: The authors studied the influence of CO2 pneumoperitoneum on intracellular pH and signal transduction arising from cancer cell multiplication in laparoscopic tumor operation. Method: They set up a simulation o...Object: The authors studied the influence of CO2 pneumoperitoneum on intracellular pH and signal transduction arising from cancer cell multiplication in laparoscopic tumor operation. Method: They set up a simulation of pneumoperitoneum under different CO2 pressure, and then measured the variation of intracellular pH (pHi) at different time and the activity of protein kinase C (PKC) and protein phosphatase 2a (PP2a) at the end of the pneumoperitoneum. After 1 week, the concentration of cancer cells in the culture medium was calculated. Result: When the pressure of CO2 pneumoperitoneum was 0, 10, 20, 30 mmHg respectively, the average pHi was 7.273, 7.075, 6.783, 6.693 at the end of the pneumoperitoneum; PKC activity was 159.4, 168.5,178.0, 181.6 nmol/(g.min) and PP2a was 4158.3, 4066.9, 3984.0, 3878.5 nmol/(g.min) respectively. After 1 week, the cancer cells concentration was 2.15×105, 2.03×105, 2.20×105, 2.18×105 L-1. Conclusion: CO2 pneumoperitoneum could promote acidosis in cancer cells, inducing the activation of protein kinase C and deactivation of protein phosphatase 2a, but it could not accelerate the mitosis rate of the cancer cells.展开更多
Objective:The aim of this study is to evaluate the effect of CO_2 pneumoperitoneum on growth and spread of intraperitoneal tumor in an animal model.Methods:We established an animal model of epithelial ovarian cancer i...Objective:The aim of this study is to evaluate the effect of CO_2 pneumoperitoneum on growth and spread of intraperitoneal tumor in an animal model.Methods:We established an animal model of epithelial ovarian cancer in immunocompetent rat Fischer 344.Twenty rats were randomized to two groups(10rats /group):CO_2 insufflation and sham laparotomy.Tumors were excised from the rats in each group 28 days after operation.Ascites,tumor mass,local regional invasion incidence,lymph node involvement,and liver and lung metastases were evaluated.Sections of tumors were made and then the cell cycle fraction were measured by quantitating DNA in individual cells using flow cytometry analysis.The expressions of Ki-67,VEGF,and CD44v6 protein were determined using immunocytochemistry by flow cytometry.Results:Tumor mass,local regional invasion incidence and the amount of ascites were higher in CO_2 insufflation than those in laparotomy,but there were no significant differences between two groups.The expression of CD44v6 protein was higher in CO_2 insufflation than that in laparotomy(P=0.002).There was no significant difference between two groups in the cells cycle fraction and the expressiones of Ki-67 and VEGF protein.Conclusions:CO_2 pneumoperitoneum has effects on intraperitoneal tumor growth and metastasis in the animal model.展开更多
目的:观察妇科腹腔镜手术CO2气腹合并体位改变对心脏电生理的影响。方法:选择择期行妇科腹腔镜手术的患者30例,全身麻醉,气腹压12 mm Hg,头低位15°。记录并分析麻醉前(T0)、麻醉后(T1)、气腹后1 min(T2)、气腹头低位后30 min(T3)...目的:观察妇科腹腔镜手术CO2气腹合并体位改变对心脏电生理的影响。方法:选择择期行妇科腹腔镜手术的患者30例,全身麻醉,气腹压12 mm Hg,头低位15°。记录并分析麻醉前(T0)、麻醉后(T1)、气腹后1 min(T2)、气腹头低位后30 min(T3)、放气平卧位后30 min(T4)时的基本监测指标和QT间期(QT)、T波峰末间期(Tp-e),心率校正QT间期(QTc),QT离散度(QTd),Tp-e/QT的变化。结果:与T0时刻相比,T1时刻QTd明显延长(P<0.05),T2、T3、T4时刻QT、QTc、QTd、Tp-e、Tp-e/QT明显延长(P<0.05);与T2时刻相比,T3时刻QTc、QTd、Tp-e、Tp-e/QT明显延长(P<0.05)。结论:妇科腹腔镜手术中CO2气腹合并头低脚高位会延长心室复极时程,破坏心脏电生理稳定性,可能增加心血管事件发生率。展开更多
基金Project supported by Research and Development Funds of Second Affiliated Hospital, School of Medicine, Zhejiang University, China
文摘Object: The authors studied the influence of CO2 pneumoperitoneum on intracellular pH and signal transduction arising from cancer cell multiplication in laparoscopic tumor operation. Method: They set up a simulation of pneumoperitoneum under different CO2 pressure, and then measured the variation of intracellular pH (pHi) at different time and the activity of protein kinase C (PKC) and protein phosphatase 2a (PP2a) at the end of the pneumoperitoneum. After 1 week, the concentration of cancer cells in the culture medium was calculated. Result: When the pressure of CO2 pneumoperitoneum was 0, 10, 20, 30 mmHg respectively, the average pHi was 7.273, 7.075, 6.783, 6.693 at the end of the pneumoperitoneum; PKC activity was 159.4, 168.5,178.0, 181.6 nmol/(g.min) and PP2a was 4158.3, 4066.9, 3984.0, 3878.5 nmol/(g.min) respectively. After 1 week, the cancer cells concentration was 2.15×105, 2.03×105, 2.20×105, 2.18×105 L-1. Conclusion: CO2 pneumoperitoneum could promote acidosis in cancer cells, inducing the activation of protein kinase C and deactivation of protein phosphatase 2a, but it could not accelerate the mitosis rate of the cancer cells.
文摘Objective:The aim of this study is to evaluate the effect of CO_2 pneumoperitoneum on growth and spread of intraperitoneal tumor in an animal model.Methods:We established an animal model of epithelial ovarian cancer in immunocompetent rat Fischer 344.Twenty rats were randomized to two groups(10rats /group):CO_2 insufflation and sham laparotomy.Tumors were excised from the rats in each group 28 days after operation.Ascites,tumor mass,local regional invasion incidence,lymph node involvement,and liver and lung metastases were evaluated.Sections of tumors were made and then the cell cycle fraction were measured by quantitating DNA in individual cells using flow cytometry analysis.The expressions of Ki-67,VEGF,and CD44v6 protein were determined using immunocytochemistry by flow cytometry.Results:Tumor mass,local regional invasion incidence and the amount of ascites were higher in CO_2 insufflation than those in laparotomy,but there were no significant differences between two groups.The expression of CD44v6 protein was higher in CO_2 insufflation than that in laparotomy(P=0.002).There was no significant difference between two groups in the cells cycle fraction and the expressiones of Ki-67 and VEGF protein.Conclusions:CO_2 pneumoperitoneum has effects on intraperitoneal tumor growth and metastasis in the animal model.
