The Studies On The Effects Of CO₂ Pneumoperitioneum On Gastrointestinal Hormones And Motivity

ObjectiveTo study the Effects of the O₂ gas replacement of the abdomen CO₂ gas upon gastrointestinal motivity after laparoscopic cholecystectomy.MethodsDivided 30 patients into 2 groups at random, 15 of whom (Group A) received O₂ gas replacement of the abdomen CO₂ after LC with CO₂ pneumoperitioneum, the other 15 (Group B) did not. The changes in EGG, the dissociative gas in abdomen, the pressure of abdomen, the peristaltic sound recovery iming (PSRT) and the anorectum exhaust timing (AET) were compared before and after operation.Results(1) In Group A, 13 cases' pnenmoperitoneum were absorbed in 72 hours, counting 86.67%. In Group B 2 cases' pnenmoperitoneum were absorbed completely in 72 hours, counting 13.33%. Its difference was significant. (2)There was no significant difference about gastrointestinal hormones 24 hours before operation and the first day after operation(P>0.05 ). In 72 hours after operation in Group B, gastric electrical swing and normal ratio of slow waves were lower significantly (P<0.05) (3) In Group A, PSRT resumed 6-26 hours later and AET resumed 17-40 hours later; in Group B PSRT resumed 18-40 hours later and AET resumed 38-87 hours later. And the abdomen pressure in Group A recovered more quickly. Conclusion(1) Different gas pnenmoperitoneums may cause abnormal gastric electrical motion and changes in abdomen pressure, and may detain gastrointestinal motivity. (2) The gastric electrical swing and the normal ratio of slow waves in CO₂ pnenmoperitoneum group resumed sooner. (3) The abdomen pressure resumed more slowly but in CO₂ pnenmoperitoneum group the gastrointestinal motivity recovered sooner in O₂ pnenmoperitoneum group. (4) CO₂ can be absorbed favorably and can make the post-operative abdomen pressure recover sooner, thus was helpful to the recovery of gastrointestinal motivity. ObjectiveTo study the changes of gastrointestinal hormones with O₂ gas replacement of the abdomen gas after laparoscopic cholecystectomy(LC).Methods30 patients was divided into 2 groups at random, 15 of whom (Group A) received O₂ gas replacement of the abdomen CO₂ after LC with CO₂ pneumoperitioneum, the other 15 (Group B) did not. Compared the changes in MOT, GAS,CCK, CGRP, GLUC before and after operation.Results(1) Before the operation and 24 hours later, the difference of motilin(MOT), gastrin(GAS) , Cholecystokinin(CCK) , glucagons(GLUC) , calcitonin gene-related peptide(CGRP) were insignificantly between two groups (P>0.05). (2) Comparatively, in both Group A and Group B MOT and GAS got less significantly(P<0.01); CCK, GLP went up significantly(P<0.01); and CGRP got higher insignificantly(P<0.05). (3) 72 hours after operation, the levels of MOT and GAS were lower significantly in Group B (P<0.05); while the difference of CCK, CGRP, GLUC between two groups was not significant (P>0.05). (4) 72 hours after operation, compared with those before operation, the difference of MOT, GAS, CCK, CGR, GLUC was not significant(P>0.05) in Group A; the levels of MOT, GAS were still lower than that before operation significantly (P<0.05), and the levels of CCK, GLUC change were insignificantly in Group B (P>0.05).Conclusion(1) Different gases may lead to different abdomen pressures and various changes in levels of gastrointestinal hormones. (2) The level changes of the five hormones were investigated in this study before or after operation, the changes of MOT and GAS were the most alike in different pneumoperitioneums and the following recovery of gastrointestinal motivity, it showed that the two hormones may be play a key part in the inhibition caused by pneumoperitioneum and the following motivity recovery. (3) CCK,GLUC as the inhibiting hormones to gastrointestinal motivity got more in 24h after pneumoperitioneum, which may be harmonious with the level of activating hormones, and cause the gastrointestinal motivity in early post-operation stage. (4) The levels of CGRP differed insignificantly before and 24h or 72h after operation, indicating different gases and abdominal pressures did not influence secretion greatly. ObjectiveIn order to supply the evidence for CO₂ pneumoperitioneum's rationality, study the effects of CO₂ pneumoperitioneum on the gastrointestinal motivity and the gastrointestinal hormones' regulative mechanism.MethodsPut 30 incross dogs into 3 groups: Group A (control group), Group B (CO₂ pneumoperitioneum group) and Group C (O₂ pneumoperitioneum group). Anesthetize Group A, fill Group B with O₂ and Group C with CO₂. Observe and compare gastrointestinal hormones and Electrogastrogram(EGG) in the three groups right after anesthesia, O₂ pneumoperitioneum and CO₂ pneumoperitioneum, 24 hours later and 72 hours later.ResultsThe pre-operation gastric electrical amplitudes, normal ratios of slow waves, average frequencies and gastrointestinal hormones in three groups differed insignificantly (P>0.05). In 24 hours after operation, the gastric electrical amplitude, normal ratios of slow waves, MOT and GAS in Group B and C were lower than those in control group, so the difference between groups were significant (P<0.01). CCK, GLUC got much more than that before operation (P<0.01); the levels of CCK in Group B and C were both higher than that in control group significantly (P<0.01); but GLUC in three groups differed insignificantly (P>0.05).The average frequency and gastriointestical hormones, CCK, GLUC and CGRP differed insignificantly between any two groups (P>0.05). In 72 hours after operation, there was no significant difference for the test items in Group A and B. Comparatively, in Group C the gastric electrical amplitude, normal ratios of slow wave, MOT and GAS were averagely lower than those in the other two groups, thus the difference was significantly (P<0.01). But the average frequencies, CCK, GLP and CGRP differed insignificantly (P>0.05). All the data showed that in O₂ pneumoperitioneum group, the post-operation gastric electrical amplitude, normal ratio of slow waves resumed more slowly, and MOT, GAS were lower than those in CO₂ pneumoperitioneum group.Conclusion(1) CO₂ pneumoperitioneum and O₂ pneumoperitioneum can both cause the abnormal gastrointestinal motivity and thus detain it. (2) In O₂ pneumoperitioneum the level of MOT was obviously lower than that in CO₂ pneumoperitioneum group, and the gastrointestinal motivity recovered slower. (3) Although CO₂ could cause hypercapnia during or after operation and could influence body breathing and cardiovascular system unfavorably, the gastrointestinal motivity in CO₂ pneumoperitioneum group recovered sooner. (4) The sooner recovery of MOT and the GAS in CO₂ pneumoperitioneum was helpful to gastrointestinal motivity. Therefore CO₂ is still a good choice as pneumoperitioneum gas at present.