低气腹压辅助悬吊式腹腔镜胆囊切除术治疗老年急性胆囊炎患者临床疗效  

Clinical efficacy of hypopneumoperitoneum pressure assisted suspended laparoscopic cholecystectomy in the treatment of acute cholecystitis in elderly patients

作　　者：刘江华 Liu Jianghua(General surgery department,Anyang second people's hospital,Anyang,Henan,455000,China)

机构地区：[1]安阳市第二人民医院普外科,河南安阳455000

出　　处：《齐齐哈尔医学院学报》2021年第14期1243-1246,共4页Journal of Qiqihar Medical University

摘　　要：目的分析低气腹压辅助悬吊式腹腔镜胆囊切除术治疗老年急性胆囊炎患者的临床疗效。方法选择2018年5月—2020年9月本院接收的110例老年急性胆囊炎患者作为研究对象,按照随机数表法分为低气腹组和常规组两组,每组各55例。低气腹组接受低气腹压辅助悬吊式腹腔镜胆囊切除术治疗,常规组接受常规气腹腹腔镜手术治疗。比较两组围手术期指标(手术时间、住院时间、下床活动时间、肛门排气时间)、气腹前、气腹5 min、15 min、气腹放尽5 min呼吸循环功能指标[收缩压(SBP)、呼气末二氧化碳浓度(ETCO_(2))、心率(HR)、气道压]以及术前、术后2 h、4 h、8 h肠屏障功能指标[D-乳酸、二胺氧化酶(DAO)]、术前、术后24 h、72 h创伤应激[血管紧张素Ⅱ(AngⅡ)、皮质醇(Cortisol,Cor)、去甲肾上腺素(NE)]。结果两组患者手术时间、住院时间、下床活动时间、肛门排气时间比较,差异无统计学意义(P>0.05);气腹5 min,两组患者HR比较,差异无统计学意义(P>0.05);气腹5 min,低气腹组患者的SBP、ETCO_(2)、气道压小于常规组,差异有统计学意义(P<0.05);气腹15 min、气腹放尽5 min,低气腹组患者的SBP、ETCO_(2)、HR、气道压小于常规组,差异有统计学意义(P<0.05);术前、术后2 h、4 h、8 h,两组患者血清DAO、D-乳酸水平比较,差异无统计学意义(P>0.05);术后24 h、72 h,低气腹组患者血清AngⅡ、Cor、NE水平低于常规组,差异有统计学意义(P<0.05)。结论常规气腹腹腔镜手术与低气腹压辅助悬吊式腹腔镜胆囊切除术治疗老年急性胆囊炎患者效果相似,均无明显肠屏障功能异常;但低气腹压辅助悬吊式腹腔镜胆囊切除术可改善呼吸循环功能,抑制创伤应激。Objective To analyze the clinical efficacy of hypopneumoperitoneum pressure-assisted suspended laparoscopic cholecystectomy for elderly patients with acute cholecystitis.Methods From May 2018 to September 2020,110 elderly patients with acute cholecystitis admitted to Anyang second people’s hospital were selected as the research objects.According to random number table method,they were divided into hypopneumoperitoneum group and conventional group,with 55 cases in each group.Patients in the hypopneumoperitoneum group received hypopneumoperitoneum pressure-assisted suspension laparoscopic cholecystectomy,and patients in the conventional group received conventional pneumoperitoneum laparoscopic surgery.The perioperative indicators(operating time,hospitalization time,time to get out of bed,and anal exhaust time),respiratory and circulatory function indexes[systolic pressure(SBP),end tidal carbon dioxide concentration(ETCO_(2)),heart rate(HR),airway pressure]before pneumoperitoneum,5 minutes and 15 minutes after pneumoperitoneum,and 5 minutes at pneumoperitoneum discharge,intestinal barrier function indexes[D-lactate,Diamine oxidase(DAO)]before operation,2 h,4 h,and 8 h after operation,traumatic stress[angiotensinⅡ(AngⅡ),cortisol(Cor),norepinephrine(NE)]before operation,24 h and 72 h after operation were compared between two groups.Results There was no significant difference between the two groups in operation time,hospitalization time,time to get out of bed,and anal exhaust time(P>0.05).There was no significant difference in HR between the two groups after 5 minutes of pneumoperitoneum(P>0.05).The SBP,ETCO_(2),and airway pressure of the hypopneumoperitoneum group were lower than those in the conventional group at 5 minutes after pneumoperitoneum(P<0.05).At 15 minutes after pneumoperitoneum and 5 minutes after the discharge of pneumoperitoneum,the SBP,ETCO_(2),HR,and airway pressure of the hypopneumoperitoneum group were lower than those in the conventional group(P<0.05).There was no significant difference in se

关 键 词：低气腹压 悬吊式腹腔镜胆囊切除术 急性胆囊炎 常规气腹腹腔镜手术 创伤应激 

分 类 号：R657.4[医药卫生—外科学]