[1]崔贺华,刘云贺,何笑雨.二氧化碳气腹压对行腹腔镜胆囊切除术患者血流动力学及胃肠功能影响[J].新乡医学院学报,2016,33(4):321-324.[doi:10.7683/xxyxyxb.2016.04.019]
　CUI He-hua,LIU Yun-he,HE Xiao-yu.Effect of carbon dioxide pneumoperitoneal pressure on the hemodynamics and gastrointestinal function of patients underwent laparoscopic cholecystectomy[J].Journal of Xinxiang Medical University,2016,33(4):321-324.[doi:10.7683/xxyxyxb.2016.04.019]
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二氧化碳气腹压对行腹腔镜胆囊切除术患者血流动力学及胃肠功能影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
33
期数:
2016年4
页码:
321-324
栏目:
临床研究
出版日期:
2016-04-06

文章信息/Info

Title:
Effect of carbon dioxide pneumoperitoneal pressure on the hemodynamics and gastrointestinal function of patients underwent laparoscopic cholecystectomy
作者:
崔贺华; 刘云贺; 何笑雨
（漯河市第三人民医院外一科，河南　漯河　462000）
Author(s):
CUI He-hua; LIU Yun-he; HE Xiao-yu
(Department of Surgery,the Third People′s Hospital of Luohe City,Luohe 462000,Henan Province,China)
关键词:
腹腔镜胆囊切除术; 二氧化碳气腹压; 血流动力学; 胃肠功能
Keywords:
laparoscopic cholecystectomy; carbon dioxide pneumoperitoneal pressure; hemodynamics; gastrointestinal function
分类号:
R657.4
DOI:
10.7683/xxyxyxb.2016.04.019
文献标志码:
A
摘要:
目的　探讨二氧化碳（CO2）气腹压对腹腔镜胆囊切除术（LC）患者血流动力学及胃肠功能的影响。方法　选取2013年8月至2015年2月于漯河市第三人民医院行择期LC患者80例，根据CO2气腹压分为低腹压组46例和高腹压组34例，低腹压组患者CO2气腹压为12 mmHg（1 mmHg=0.133 kPa），高腹压组患者CO2气腹压为15 mmHg，比较2组患者气腹时的血气分析及血流动力学指标、手术前后肝功能、术后胃肠功能恢复时间及并发症发生率。结果　2组患者气腹前平均动脉压（MAP）、心率（HR）比较差异均无统计学意义（P>0.05)；2组患者气腹10、20 min时HR显著高于气腹前（P<0.05），2组患者气腹20 min时MAP显著高于气腹前（P<0.05）；低腹压组气腹10、20 min 时MAP和HR均显著低于高腹压组（P<0.05）。2组患者气腹前动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、酸碱度（pH）比较差异均无统计学意义（P>0.05)；2组患者气腹10、20 min时PaCO2显著高于气腹前（P<0.05），PaO2显著低于气腹前（P<0.05）；气腹前后2组患者pH值比较差异均无统计学意义（P>0.05)；低腹压组患者气腹10、20 min时PaCO2显著低于高腹压组（P<0.05），PaO2显著高于高腹压组（P<0.05）。2组患者术前天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、总胆红素(TBIL)水平比较差异均无统计学意义（P>0.05)，2组患者术后AST、ALT、TBIL水平均显著高于术前（P<0.05），术后低腹压组患者AST、ALT、TBIL水平均显著低于高腹压组（P<0.05）。低腹压组患者肠鸣音出现时间、肠道排气时间、进食时间均显著短于高腹压组（P<0.05）。低腹压组和高腹压组患者术后并发症发生率分别为8.70%（4/46）和26.47%（9/34），低腹压组患者术后并发症发生率显著低于高腹压组（P<0.05）。结论　CO2气腹会影响行LC患者多系统功能，在保证手术视野清晰的情况下，应尽量降低气腹压力，以减少对患者的不良影响，促进患者恢复，提高手术安全性。
Abstract:
Objective　To investigate the effect of carbon dioxide(CO2) pneumoperitoneal pressure on the hemodynamics and gastrointestinal function of patients underwent laparoscopic cholecystectomy(LC).Methods　Eighty patients who underwent selective LC in the Third People′s Hospital of Luohe City from August 2013 to February 2015 were divided into low pneumoperitoneal pressure group(46 cases) and high pneumoperitoneal pressure group(34 cases) according to CO2 pneumoperitoneal pressure.The CO2 pneumoperitoneal pressure of patients in low pneumoperitoneal pressure group was 12 mmHg(1 mmHg=0.133 kPa),while that in high pneumoperitoneal pressure group was 15 mmHg.The blood gas analysis indexes,hemodynamic indexes,perioperative liver function,postoperative gastrointestinal function recovery time and complication incidence were compared between the two groups.Results　There was no significant difference in mean arterial blood pressure(MAP) and heart rate(HR) between the two groups before pneumoperitoneum(P>0.05).The HR of patients at 10 and 20 minutes after the beginning of pneumoperitoneum was significantly higher than that before pneumoperitoneum in the two groups(P<0.05).The MAP of patients at 20 minutes after the beginning of pneumoperitoneum was significantly higher than that before pneumoperitoneum in the two groups(P<0.05).The MAP and HR of patients in low pneumoperitoneal pressure group were significantly lower than those in high pneumoperitoneal pressure group at 10 and 20 minutes after the beginning of pneumoperitoneum(P<0.05).There was no significant difference in partial pressure of carbon dioxide in artery(PaCO2),partial pressure of oxygen in artery(PaO2) and power of hydrogen(pH) between the two groups before pneumoperitoneum(P>0.05).The PaCO2 of patients at 10 and 20 minutes after the beginning of pneumoperitoneum was significantly higher than that before pneumoperitoneum in the two groups(P<0.05),but the PaO2 decreased significantly(P<0.05).There was no significant difference in pH between the two groups before and after pneumoperitoneum(P>0.05).The PaCO2 of patients in low pneumoperitoneal pressure group were significantly lower than that in high pneumoperitoneal pressure group at 10 and 20 minutes after the beginning of pneumoperitoneum(P<0.05),but the PaO2 of patients in low pneumoperitoneal pressure group were significantly higher than that in high pneumoperitoneal pressure group(P<0.05).There was no significant difference in partial pressure of carbon dioxide in aspartate aminotransferase(AST),alanine transarninase(ALT) and total bilirubin(TBIL) between the two groups before pneumoperitoneum(P>0.05).The levels of AST,ALT and TBIL of patients after operation were significantly higher than those before operation in the two groups(P<0.05).The levels of AST,ALT and TBIL in low pneumoperitoneal pressure group were significantly lower than those in high pneumoperitoneal pressure group after operation(P<0.05).The borborygmus emergence time,intestinal exhaust time and start eating time in low pneumoperitoneal pressure group were significantly shorter than those in high pneumoperitoneal pressure group after operation(P<0.05).The rate of postoperative complication in low pneumoperitoneal pressure group and high pneumoperitoneal pressure group was 8.70%(4/46) and 26.47%(9/34) respectively,the rate of postoperative complication in low pneumoperitoneal pressure group was significantly lower than that in high pneumoperitoneal pressure group(P<0.05).Conclusion　CO2 pneumoperitoneum can affect the multiple system function of patients underwent LC.Under the condition that the operation field of vision is clear,the pneumoperitoneal pressure should be minimized to reduce the adverse effect,promote the recovery of patients,and improve the operative safety.

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更新日期/Last Update: 2016-04-05