不同气腹压力对腹腔镜胆囊切除术后短期并发症的影响  

Impact of different pneumoperitioneum pressures on the short-term complications following laparoscopic cholecystectomy

作　　者：申海军[1] 陈广瑜[1] 詹建兴 胡博[1] 成广海[1] 付振刚[1] 王斌[1] 高辉[1] 石景森[2] 

机构地区：[1]西安航天总医院肝胆外科,陕西西安710100 [2]西安交通大学第一附属医院普通外科,陕西西安710061

出　　处：《中国普通外科杂志》2012年第2期149-152,共4页China Journal of General Surgery

摘　　要：目的：探讨不同CO2气腹压力对腹腔镜胆囊切除（LC）术后肝功能、动脉血气及对颈肩部疼痛的影响。方法：选择行择期LC术患者120例，随机分为A，B，C3组，每组40例。A组气腹压力设置为10mmHg（1mmHg=0．133kPa），B组为12mmHg，C组为14mmHg。对比分析3组手术前后肝功能、血气指标及术后1-3d恶心呕吐、颈肩部疼痛的发生率。结果：术前3组间各参数比较差异无统计学意义（均P〉0．05），但术后3组间肝功能、血气指标改变及恶心呕吐、颈肩部疼痛的发生率均有明显差异（均P〈0．05）。结果显示，气腹压力越大，术后肝功能（AST，ALT，TBIL升高）和血气指标（PCO2升高，pH，P02下降）变化越明显，且术后颈、肩痛及恶心呕吐发生率越高。结论：气腹压力对LC术后肝功能，动脉血气，颈，肩痛及恶心呕吐有明显影响，故术中应尽量降低气腹压力。Objective： To investigate the influences of different pressures of CO2 pneumoperitioneum on liver function, arterial blood gas, and neck or shoulder pain following laparoscopic cholecystectomy （LC）. Methods： One hundred and twenty patients scheduled for elective LC were randomly assigned to group A,B and C, with 40 cases in each group. The CO2 pneumoperitoneum pressure was maintained at 10 mmHg ingroup A, 12 mmHg in group B and 14 mmHg in the group C. The liver function and blood gas parametersbefore and after operation, and the incidences of nausea, vomiting, and neck or shoulder pain on the first to third postoperative day of the three groups were compared and analyzed. Results： The preoperative data among the three groups had no statistical differences （all P〉0.05）, but the parameters of liver function and arterial blood gas as well as the incidence of nausea, vomiting, and neck or shoulder pain after operation were all significantly different among them （all P〈0.05）. The results showed thatthe higher the pneumoperitioneum pressure was increased, the more significantly did the parameters of liver function （increase of AST, ALT and TBIL） and arterial blood gas （increases of PO2, and decrease of pH and PCO2 ） change, and the higher was the incidence of nausea, vomiting, and neck or shoulder pain. Conclusion： The CO2 pneumoperitioneum pressure has significant impact on incidence of liver function abnormalities, arterial blood gas derangements, and neck or shoulder pain following LC. Therefore, the pneumoperitioneum pressure should be decreased as low as possible during operation.

关 键 词：胆囊切除术 腹腔镜 气腹 人工 肝功能试验 血气分析 手术后并发症 

分 类 号：R657.4[医药卫生—外科学]