不同气腹压及肌松程度对后腹腔镜手术患者腹膜后空间、术野满意度及凝血、应激指标的影响  

Effects of Different Degrees of Pneumoperitoneum Pressure and Muscle Relaxation on Retroperitoneal Space,Surgical Field Satisfaction and Indexes of Blood Coagulation and Stress in Patients Undergoing Retroperitoneal Laparoscopic Surgery

作　　者：董文泽 张丽伟[1] 张莉莉[1] 贾倩倩[1] DONG Wen-ze;ZHANG Li-wei;ZHANG Li-li;JIA Qian-qian(Department of Anesthesiology,the First Hospital of Qinhuangdao,Qinhuangdao,Hebei 066000,China)

机构地区：[1]秦皇岛市第一医院麻醉科,河北秦皇岛066000

出　　处：《临床误诊误治》2022年第2期92-96,共5页Clinical Misdiagnosis & Mistherapy

基　　金：秦皇岛市科学技术研究与发展计划项目(201805A035)。

摘　　要：目的探讨不同气腹压及肌松程度对后腹腔镜手术患者腹膜后空间、术野满意度及凝血、应激指标的影响。方法选取2019年8月—2021年2月行后腹腔镜手术的患者72例,根据气腹压及肌松程度不同分为A组和B组,每组36例,两组均采用常规后腹腔镜体位及全静脉麻醉,A组采用低气腹压及深度肌松,B组采用高气腹压及中度肌松。比较两组腹膜后空间、术野满意度,以及气腹建立前、建立气腹60 min(T1)、手术结束时(T2)凝血和应激指标。结果A组腹膜后间隙的深度小于B组(P<0.01)。两组腹膜后间隙上下缘长度和前后缘长度以及术野满意度比较差异无统计学意义(P>0.05)。两组凝血酶原时间、活化部分凝血活酶时间(APTT)在不同时间点呈下降趋势,纤维蛋白原(Fib)、D-二聚体(D-D)、去甲肾上腺素(NE)、皮质醇(Cor)在不同时间点呈上升趋势(P<0.05)。A组在T1、T2时APTT长于B组,Fib、D-D、NE、Cor低于B组(P<0.05)。结论低气腹压及深度肌松应用于后腹腔镜手术安全有效,能够提供满意术野,且对机体凝血、应激反应影响较小。Objective To investigate effects of different degrees of pneumoperitoneum pressure and muscle relaxation on retroperitoneal space,surgical field satisfaction,and indexes blood coagulation and stress in patients undergoing retroperitoneal laparoscopic surgery.Methods A total of 72 patients who had undergone retroperitoneal laparoscopic surgery between August 2019 and February 2021 were selected and divided into group A(n=36)and group B(n=36)according to different degrees of pneumoperitoneal pressure and muscle relaxation.Routine laparoscopic postures and total intravenous anesthesia were performed in both groups.Group A was treated with low-pressure pneumoperitoneum+deep neuromuscular blockade(NMB),while group B was treated with high-pressure pneumoperitoneum+moderate NMB.The retroperitoneal space,surgical field satisfaction,indexes of blood coagulation and stress before pneumoperitoneum establishment,after pneumoperitoneum establishment for 60 min(T1)and at the end of surgery(T2)were compared between two groups.Results The depth of retroperitoneal space in group A was smaller than that in group B(P<0.01).There were no significant differences in length from the upper to lower edges of the retroperitoneal space,the length from anterior to posterior edges of the retroperitoneal space and surgical field satisfaction between two groups(P>0.05).In two groups,prothrombin time and activated partial thromboplastin time(APTT)showed decreasing trends at different time points,while fibrinogen(Fib),D-dimer(D-D),norepinephrine(NE)and cortisol(Cor)showed increasing trends at different time points(P<0.05).At T1 and T2 in group A,APTT was significantly longer than that in group B,while Fib,D-D,NE and Cor were significantly lower than those in group B(P<0.05).Conclusion The low-pressure pneumoperitoneum and deep NMB in application of retroperitoneal laparoscopic surgery is safe and effective,and it may provide satisfactory operating field with little effects on coagulation and stress reaction of the body.

关 键 词：后腹腔镜 肌松弛 气腹压 纤维蛋白原 D-二聚体 去甲肾上腺素 皮质醇 

分 类 号：R614[医药卫生—麻醉学]