小儿腹腔镜手术二氧化碳气腹引起高血压机制的研究  

Investigation on the mechanism of hypertension induced by carbon dioxide pneumoperitoneum in laparoscopic surgery for infants

作　　者：陈帅[1] 王凤君[1] 马长松[1] 

机构地区：[1]广东省珠海市妇幼保健院麻醉科,519000

出　　处：《中国妇幼保健》2010年第22期3202-3204,共3页Maternal and Child Health Care of China

基　　金：广东省珠海市科技计划项目〔PC20041005〕

摘　　要：目的:探讨小儿腹腔镜手术二氧化碳(CO2)气腹引起血管活性物质的变化从而引起高血压的机制,以其结果为腹腔镜手术的麻醉监测和用药提供指导。方法:观察组为92例小儿腹腔镜手术,年龄2.5～14岁;对照组为10名健康体检小儿,年龄3～14岁。术中麻醉采用对心血管影响较小的丙泊酚静脉麻醉,辅助瑞芬太尼镇痛以排除麻醉方式及麻醉用药对结果的影响。分别检测观察组麻醉前及CO2气腹后30min以及对照组静脉血中一氧化氮(NO),内皮素-1(ET-1),血管紧张素-Ⅱ(Ang-Ⅱ),肾素(PRA),醛固酮(ALD)浓度,同时检测血压。所有数据采用SPSS13.0软件进行统计学处理。结果:该组发现小儿腹腔镜CO2气腹后30min血压升高达78.26%,同时血中NO量浓度下降,ET-1上升;术中CO2气腹30min后PRA,Ang-Ⅱ,ALD升高。相关分析结果显示:血压与NO量呈负相关(r=-3.59,P<0.05),与ET-1(r=4.35,P<0.01)、PRA(r=3.37,P<0.05)、Ang-2(r=3.27,P<0.01)、ALD(r=2.78,P<0.05)呈正相关,与二氧化碳分压(PaCO2)呈线性相关。结论:术中血管活性物质释放增加可刺激血压升高,手术中应加强监测,麻醉采用丙泊酚具有易控性强,恢复时间早的特点,可保护NO系统也可减少CO2气腹的副作用。Objective：To explore the mechanism of hypertension induced by changes of vasoactive substances because of carbon dioxide pneumoperitoneum in laparoscopic surgery for infants,provide a basis for anesthesia monitoring and medication guidance in laparoscopic surgery based on the results.Methods：92 infants aged 2.5～14 years old undergoing laparoscopic surgery were selected as observation group,10 healthy infants aged 3～14 years old were selected as control group,intravenous anesthesia of propofol with minimal effect on cardiovascular system was adopted for intraoperative anesthesia,remifentanil was added in order to exclude the effects of anesthesia methods and drug usage on results; the levels of nitric oxide （NO）,endothelin-I （ET-I）,angiotensin-Ⅱ （Ang-Ⅱ）,renin （PRA）,aldosterone （ALD） in venous blood before anesthesia and 30 minutes after carbon dioxide pneumoperitoneum in observation group and control group were detected,at the same time,blood pressure was measured.Results：The blood pressure increased by 78.26% at 30 minutes after carbon dioxide pneumoperitoneum in observation group,at the same time,the level of NO decreased,the level of ET-I increased; the levels of PRA,Ang-I and ALD increased at 30 minutes after carbon dioxide pneumoperitoneum during laparoscopic surgery; there was a negative correlation between blood pressure and NO level （γ=-3.59,P〈0.05）,and there was a positive correlation between blood pressure and ET-I （γ=4.35,P〈0.01）,PRA （γ=3.37,P〈0.05）,Ang-II （γ=3.27,P〈0.01） and AID （γ=2.78,P〈0.05）,there was a linear correlation between blood pressure and partial pressure of carbon dioxide.Conclusion：The increase of vasoactive substances release may stimulate the increase of blood pressure,intraoperative monitoring should be strengthened,propofol has the advantages of easy to control and early recovery time,which can protect NO system and reduce the adverse reactions of carbon dioxide pneumoperitoneum.

关 键 词：小儿 腹腔镜 二氧化碳 高血压 血管活性物质 

分 类 号：R445[医药卫生—影像医学与核医学]