CO2 pneumoperitoneum modifies the inflammatory response to sepsis
CO2 pneumoperitoneum modifies the inflammatory response to sepsis
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DOI：
10.1097/00000658-200303000-00007
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发表时间：
2003-03-01
影响因子：
9
通讯作者：
Talamini, MA
中科院分区：
文献类型：
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作者：
Hanly, EJ;Mendoza-Sagaon, M;Talamini, MA
目的分析CO2气腹对腹腔镜脓毒症所致炎症反应的影响。越来越多的证据挑战了曾经普遍接受的观念，即较小的切口单独说明腹腔镜入路的观察到的好处。此外，腹腔镜手术现在被广泛应用于患者，包括那些炎症反应被点燃的患者。需要描述CO2气腹膜对脓毒症引起的炎症反应的影响。方法采用开腹或腹腔镜下盲肠结扎穿刺法（CLP）诱导大鼠脓毒症，充气气体为CO2或氦气。术后24小时处死动物，取全血进行全血细胞计数，取肝脏分析大鼠急性期基因α 2-巨球蛋白和β -纤维蛋白原的肝脏表达。结果与氦气和开放式CLP相比，CO2腹腔镜CLP可显著降低大鼠肝脏急性期基因α 2-巨球蛋白的表达。另一种大鼠急性期基因β -纤维蛋白原的肝脏表达与α 2-巨球蛋白相似，并且在CO2腹腔镜CLP后与氦气腹腔镜CLP相比显著降低。在CO2腹腔镜下进行CLP时，CLP术后白细胞总数和中性粒细胞计数均显著高于开腹或氦腹腔镜下进行CLP时。结论腹腔镜术中腹腔内CO2可减轻围手术期脓毒症相关急性期炎症反应。
Objective To analyze the effect of CO2 pneumoperitoneum on the inflammatory response induced by sepsis during laparoscopy.Summary Background Data A growing body of evidence challenges the once generally accepted notion that smaller incisions alone account for the observed benefits of the laparoscopic approach. Furthermore, laparoscopic surgery is now being applied to a broad spectrum of patients, including those in whom the inflammatory response is ignited. Delineation of the effects of CO2 pneumo-peritoneum on the inflammatory response induced by sepsis is needed.Methods Sepsis was induced in rats by cecal ligation and puncture (CLP) performed either open or laparoscopically using CO2 or helium as insufflation gases. Animals were killed 24 hours postoperatively, at which time whole blood was collected for complete blood cell counts and livers were harvested for analysis of hepatic expression of the rat acute phase genes alpha2-macroglobulin and beta-fibrinogen.Results Laparoscopic CLP using CO2 resulted in significantly reduced hepatic expression of the rat acute phase gene alpha2-macroglobulin compared to both laparoscopic CLP using helium and open CLP. Hepatic expression of another rat acute phase gene, beta-fibrinogen, paralleled that of alpha2-macroglobulin and was significantly reduced following laparoscopic CLP using CO2 compared to laparoscopic CLP using helium. Total white blood cell and neutrophil counts following CLP were both significantly higher when CLP was performed laparoscopically using CO2 than when CLP was performed open or laparoscopically using helium.Conclusions Intra-abdominal CO2 present during laparoscopy attenuates the acute phase inflammatory response associated with perioperative sepsis.