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  

Effect of carbon dioxide pneumoperitoneal pressure on the hemodynamics and gastrointestinal function of patients underwent laparoscopic cholecystectomy

作　　者：崔贺华[1] 刘云贺[1] 何笑雨 

机构地区：[1]漯河市第三人民医院外一科,河南漯河462000

出　　处：《新乡医学院学报》2016年第4期321-324,共4页Journal of Xinxiang Medical University

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 mm Hg(1 mm Hg=0.133 k Pa),高腹压组患者CO2气腹压为15 mm Hg,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(Pa CO2)、动脉血氧分压(Pa O2)、酸碱度(p H)比较差异均无统计学意义(P>0.05);2组患者气腹10、20 min时Pa CO2显著高于气腹前(P<0.05),Pa O2显著低于气腹前(P<0.05);气腹前后2组患者p H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Pa CO2显著低于高腹压组(P<0.05),Pa O2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。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 mm Hg（ 1 mm Hg = 0. 133 k Pa）,while that in high pneumoperitoneal pressure group was 15 mm Hg. 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 MApof 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（ Pa CO2）,partial pressure of oxygen in artery（ Pa O2） and power of hydrogen（ p H） between the two groups before pneumoperitoneum（ P〈0. 05）. The Pa CO2 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）,bu

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 

分 类 号：R657.4[医药卫生—外科学]