不同气腹压对后腹腔镜手术患者应激因子、肝肾功能影响研究  

The Influence of different pneumoperitoneum pressures on stress factors and liver-kidney function in patients undergoing retroperitoneal laparoscopic surgery

作　　者：王国瑞 孙宏宇 夏海禄 刘文平 王建华 柳洁 WANG Guo-rui;SUN Hong-yu;XIA Hai-lu;LIU Wen-ping;WANG Jian-hua;LIU Jie(Department of Anesthesiology,Cangzhou Hospital of Integrated TCM-WM·Hebei,Cangzhou 061000,China)

机构地区：[1]沧州中西医结合医院麻醉科,河北沧州061000 [2]沧州市新华区车站街道办事处社区卫生服务中心,河北沧州061000

出　　处：《创伤与急危重病医学》2021年第6期446-451,共6页Trauma and Critical Care Medicine

基　　金：沧州市重点研发计划指导项目(204106052)。

摘　　要：目的探究不同气腹压对后腹腔镜手术患者应激因子、肝肾功能的影响。方法将沧州中西医结合医院自2019年8月至2021年4月期间收治的120例泌尿、肿瘤外科需行后腹腔镜手术的患者随机分为A1组(中度肌松,12 mmHg低气腹压)、A2组(中度肌松,14 mmHg中气腹压)、A3组(中度肌松,16 mmHg高气腹压)、A4组(深度肌松,12 mmHg低气腹压)、A5组(深度肌松,14 mmHg中气腹压)、A6组(深度肌松,16 mmhg高气腹压)各20例。比较6组患者术中后腹腔空间,比较6组患者术前(T1)、建立气腹60 min(T2)、术毕(T3)时应激因子[血清皮质醇(Cor)、C-反应蛋白(CRP)]、凝血功能[纤维蛋白原(FIB)、D-二聚体(D-D)],比较6组患者T1及术后3 d时(T4)肝功能[谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)]、肾功能[尿素氮(BUN)、肌酐(Cr)、β2微球蛋白(β2-MG)],比较6组患者术中不良事件发生情况。结果A3组、A5组、A6组术中后腹腔空间显著高于其余各组(P<0.05)。T2、T3时,6组Cor、CRP均较T1时显著升高,且A3组、A6组显著高于A1组、A2组、A4组、A5组,差异有统计学意义(P<0.05).A1组、A2组、A4组、A5组FIB、D-D均较T1时比较,差异无统计学意义(P>0.05),A3组、A6组FIB、D-D均较T1时显著升高,差异有统计学意义(P<0.05)。T4时,6组AST、ALT、TBIL均较T1时显著升高,A3组、A6组显著高于其余4组(P<0.05)。T4时,6组BUN、Cr、β2-MG均较T1时比较,各组间比较,差异均无统计学意义(P>0.05)。结论对后腹腔镜手术患者予以深度肌松及中气腹压可为施术人员创造更大的腹膜后操作空间,相较于高气腹压更利于减轻术中应激反应,降低对凝血功能、肝功能的负面影响,具有较高的临床应用价值。Objective To explore the influence of different pneumoperitoneum pressures on stress factors and liver-kidney function in patients undergoing retroperitoneal laparoscopic surgery.Methods A retrospective study was performed on 120 patients who needed retroperitoneal laparoscopic surgery were admitted from August 2019 to April 2021.Patients were randomly divided into A1 group(moderate muscle relaxation,12 mmHg low pneumoperitoneum pressure),A2 group(moderate muscle relaxation,14 mmHg middle pneumoperitoneum pressure),A3 group(moderate muscle relaxation,16 mmHg high pneumoperitoneum pressure),A4 group(deep muscle relaxation,12 mmHg low pneumoperitoneum pressure),A5 group(deep muscle relaxation,14 mmHg middle pneumoperitoneum pressure)and A6 group(deep muscle relaxation,16 mmHg high pneumoperitoneum pressure),with 20 cases in each group.The intraoperative retroperitoneal space,stress factors[serum cortisol(Cor),C-reactive protein(CRP)]and coagulation function[fibrinogen(FIB),D-dimer(D-D)]before surgery(T1),at 60min of establishment of pneumoperitoneum(T2)and at the end of surgery(T3),liver function[aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBIL)]and renal function[blood urea nitrogen(BUN),creatinine(Cr),β2 microglobulin(β2-MG)]at T1 and at 3 d after surgery(T4)and the occurrence of intraoperative adverse events were compared among the six groups.Results The intraoperative retroperitoneal space in the A3,A5 and A6 groups was significantly higher than that in the other groups(P<0.05).At T2 and T3,the levels of Cor and CRP in the six groups were significantly increased compared with those at T1(P<0.05),and the levels in the A3 and A6 groups were significantly higher than those in the A1,A2,A4 and A5 groups(P<0.05).There were no significant changes in the levels of FIB and D-D in the A1,A2,A4 and A5 groups compared with those at T1(P>0.05),and the levels of FIB and D-D in the A3 group and A6 group were significantly increased compared to at T1,and were significantly higher than those

关 键 词：气腹压 肌松程度 后腹腔镜手术 应激 肝肾功能 

分 类 号：R614[医药卫生—麻醉学]