Effect of laparoscopic appendectomy under different pneumoperitoneum pressure on stress response and gastrointestinal function in children with acute appendicitis
Objective To investigate the effect of laparoscopic appendectomy(LA)under different pneumoperitoneum pres-sure on stress response and gastrointestinal function in children with acute appendicitis.Methods A total of 90 children with acute appendicitis who received LA treatment in Jiujiang Maternal and Child Health Hospital from July 2020 to Febru-ary 2022 were selected as the research objects.They were divided into group A(30 cases),group B(30 cases)and group C(30 cases)with random number table method.The intraoperative carbon dioxide(CO2)pneumoperitoneum pressure in group A was maintained at 8.0-9.0 mmHg,that in group B was maintained at＞9.0-10.0 mmHg and that in group C was main-tained at＞10.0-11.0 mmHg.The clarity of operation field,stress response,gastrointestinal function and local pain of the three groups were compared.Results The total excellent and good rate of surgical field definition in group B was higher than that in group A and group C,and the differences were statistically significant(P＜0.017).There was no significant difference in the total excellent and good rate of surgical field definition between group A and group C(P＞0.017).There were no sig-nificant differences in the levels of adrenocorticotropic hormone(ACTH)and cortisol(Cor)among the three groups at T0(P＞0.05).The levels of ACTH and Cor in the three groups at T1 and T2 were higher than those at T0,and the levels of ACTH and Cor at T2 were lower than those at T1,and the differences were statistically significant(P＜0.05).However,the levels of ACTH and Cor in group B at T1 and T2 were lower than those in group A and group C,and the differences were statistically significant(P＜0.05).There was no significant difference in the levels of ACTH and Cor between group A and group C at T1 and T2(P＞0.05).The recovery time of bowel sounds,the time of first anal exhaust and defecation in group B were shorter than those in group A and group C,and the differences were statistically significant(P＜0.05).There was no significant difference in the recovery time of bowel sounds,the first anal ex-haust and defecation time between group A and group C(P＞0.05).The total excellent and good rate of local pain assessment in group B was higher than that in group A and group C,and the differences were statistically significant(P＜0.017).There was no significant difference in the total excellent and good rate of local pain assessment between group A and group C(P＞0.017).Conclusion The application of LA under pneumoperitoneum pressure of＞9.0-10.0 mmHg in children with acute appendicitis can improve the clarity of the surgical field,promote the recovery of gastrointestinal function,have less impact on the stress response,and reduce local pain.
Acute appendicitis in childrenPneumoperitoneum pressureLaparoscopic appendectomyStress responseGastrointestinal function
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