机器人辅助腹腔镜下前列腺癌根治术患者上下肢血压变化与术后肝酶指标的关系  

Association of intraoperative upper and lower limb blood pressure with postoperative liver enzyme index in patients treated with robotic-assisted radical prostatectomy

作　　者：杨春[1] 汪小海[1] 陈洁[1] 徐鑫[1] 李勇[1] YANG Chun;WANG Xiaohai;CHEN Jie;XU Xin;LI Yong(Department of Anesthesiology, Drum Tower Hospital, Medical College of Nanjing University, Nanjing 210008, China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科

出　　处：《临床麻醉学杂志》2019年第5期454-457,共4页Journal of Clinical Anesthesiology

摘　　要：目的探究机器人辅助腹腔镜下前列腺癌根治术(robotic-assisted radical prostatectomy,RARP)患者术中上下肢血压变化与术后肝酶指标之间的关系及术后肝酶指标异常的危险因素。方法连续纳入2017年10月至2018年6月于我院行RARP患者110例,年龄<80岁,BMI<30 kg/m^2,ASAⅠ-Ⅲ级,均行静脉全身麻醉。患者麻醉诱导完成后至切皮前期间(T1)、气腹加头低脚高位开始至气腹结束前期间(T2),每隔10分钟测量上下肢血压,分别计算T1、T2阶段上下肢SBP、DBP和MAP的均值。术后第1天抽血行肝酶指标检查,并根据其是否异常将患者分为肝酶正常组和肝酯异常组。结果单因素分析结果显示:与T1阶段比较,T2期间上肢DBP与下肢DBP均值的变化是RARP患者术后出现肝酶指标异常的危险因素(P<0.05);多因素分析结果显示:与T1阶段比较,T2期间下肢DBP均值的下降是RARP患者术后出现肝酶指标异常的独立危险因素(P=0.019,OR=3.21,95%CI:1.212-8.504)。结论 CO2气腹加头低脚高位期间,下肢DBP均值的下降可作为RARP患者术后肝酶指标异常的预警因素。Objective To elucidate the association between intraoperative upper and lower limb blood pressure and postoperative liver enzyme index in patients treated with robotic-assisted radical prostatectomy(RARP), as well as the risk factors for postoperative liver enzyme index abnormalities. Methods A total of 110 patients treated with RARP were recruited consecutively between October 2017 and June 2018, aged <80 years, BMI<30 kg/m2, ASA grade 1-3. All patients underwent intravenous general anesthesia. During the two stages of the anesthesia induction was completed to the surgical incision(T1) and were placed at Trendelenburg until the end of the pneumoperitoneum(T2), we measured the blood pressure of upper and lower limbs every 10 minutes, calculating the average SBP, DBP and MAP of upper and lower limbs in T1 and T2 period, respectively. According to the results of liver enzyme at postoperative day 1, the patients were divided into normal liver enzyme group and abnormal liver enzyme group. Results Univariate analysis indicated that compared with T1 period, the average changes of the upper and lower limb DBP during T2 period were statistically different between the normal liver enzyme group and the abnormal enzyme group(P<0.05). Logistic regression analysis indicated that decreased mean value of the lower limb DBP during T2 period(P=0.019,OR=3.21,95%CI:1.212-8.504) was the independent risk factor of postoperative abnormal liver enzyme. Conclusion Decreased mean value of DBP in the lower limb during CO2 pneumoperitoneum and Trendelenburg can be used as a predictor of postoperative liver enzyme index abnormalities in patients with RARP.

关 键 词：机器人手术 前列腺癌切除 上下肢血压 肝酶 

分 类 号：R614[医药卫生—麻醉学] R737.25[医药卫生—外科学]