本文關(guān)鍵詞： 開放手術(shù) 腹腔鏡氣腹術(shù) 斯圖爾特 pH PaCO_2 酸堿平衡 強(qiáng)離子間隙 非揮發(fā)性弱酸總和　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 腹腔鏡外科手術(shù)中二氧化碳的充入及排出會(huì)影響機(jī)體內(nèi)酸堿平衡,此項(xiàng)研究的目的是借助彼得·斯圖爾特的方法探究腹腔鏡手術(shù)機(jī)體內(nèi)酸堿平衡的變化,并與開放手術(shù)進(jìn)行對(duì)比分析。 方法： 選取山東大學(xué)附屬省立醫(yī)院胃腸外科100個(gè)需行胃腸外科手術(shù)治療的病人,隨機(jī)分成腹腔鏡手術(shù)組(n=50)及開放手術(shù)組(n=50)。酸堿相關(guān)參數(shù)測(cè)定分別在四個(gè)時(shí)間點(diǎn)進(jìn)行：T1：麻醉誘導(dǎo)后10分鐘；T2：根據(jù)分組腹膜打開或氣腹術(shù)開始后1小時(shí)；T3：手術(shù)結(jié)束時(shí)；T4：手術(shù)結(jié)束后1小時(shí)。最后,整理所得資料,建立數(shù)據(jù)庫(kù),應(yīng)用SPSS19.0統(tǒng)計(jì)分析軟件包對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,病人的特點(diǎn)用Mann-Whitney U檢驗(yàn)或適當(dāng)?shù)那闆r用Fisher精確檢驗(yàn)進(jìn)行比較,所有測(cè)量和計(jì)算數(shù)據(jù)的分布是由單樣本柯爾莫哥洛夫-斯米爾諾夫檢驗(yàn)(Kolmogorov-Smirnov檢驗(yàn))進(jìn)行檢驗(yàn),對(duì)于其他組內(nèi)變量和數(shù)據(jù)進(jìn)行方差分析,運(yùn)用t檢驗(yàn)以比較組間差異。P值取0.05為顯著性標(biāo)準(zhǔn)。 結(jié)果： 兩組數(shù)據(jù)統(tǒng)計(jì)分析后顯示兩組間病人特點(diǎn)如年齡、性別、體重、既往史、手術(shù)時(shí)間、手術(shù)方式、術(shù)中補(bǔ)液、術(shù)后補(bǔ)液、尿量、失血量沒有顯著性差異；組織間液的剩余堿(標(biāo)準(zhǔn)剩余堿)、強(qiáng)離子間隙、陰離子間隙也沒有顯著性差異；與基準(zhǔn)值相比較,這兩組的標(biāo)準(zhǔn)剩余堿在T2、T3和T4上都是降低的；在腹腔鏡氣腹手術(shù)組的T2,鑒于PaCO2的升高使得pH較基準(zhǔn)值降低,但是當(dāng)腹腔鏡手術(shù)結(jié)束腹膜腔內(nèi)二氧化碳被排出后pH值會(huì)迅速恢復(fù)到基準(zhǔn)值水平；在開放手術(shù)組的T3和T4,伴隨著乳酸鹽和氯化物的升高,明顯的強(qiáng)離子差及pH較基準(zhǔn)值降低。 結(jié)論： 在氣腹術(shù)期間機(jī)體內(nèi)pH會(huì)隨著充氣時(shí)PaCO2的升高而降低,當(dāng)排氣后PaCO2隨之降低,pH也會(huì)逐漸恢復(fù)到正常水平。可以認(rèn)為腹腔鏡手術(shù)期間的pH值降低,呼吸是一個(gè)重要的因素。另一方面,開放手術(shù)后一個(gè)小時(shí)機(jī)體的代謝也是其pH值降低的一個(gè)因素。在開放手術(shù)組可以觀察到乳酸鹽的升高伴隨明顯的強(qiáng)離子差及pH降低,而腹腔鏡氣腹術(shù)組沒有出現(xiàn)相應(yīng)的情況。開放手術(shù)組中T3和T4乳酸是顯著升高的,這表明了開放后機(jī)體低灌注,乳酸積累密切相關(guān)。
[Abstract]:Objective: The aim of this study is to explore the changes of acid-base balance in laparoscopic surgery with the help of Peter Stewart's method. And compared with open surgery. Methods: A total of 100 patients with gastrointestinal surgery in the provincial hospital affiliated to Shandong University were selected. The patients were randomly divided into two groups: the laparoscopic group (n = 50) and the open group (n = 50). The acid-base related parameters were measured at four time points: 10 minutes after anesthesia induction; T2: according to the group of peritoneal opening or pneumoperitoneum 1 hour after the beginning; T3: at the end of the operation; T4: one hour after the operation. Finally, the data were sorted out, the database was established, and the data were analyzed by SPSS19.0 software package. The characteristics of the patient were compared with Mann-Whitney U test or, where appropriate, with Fisher precise test. The distribution of all the measured and calculated data was tested by a single sample Colmogorov-Smirnov test by the Kolmogorov-Smirnov test. For the variance analysis of variables and data in other groups, t test was used to compare the difference between groups. P value was 0.05 as the significant standard. Results: Statistical analysis of the two groups showed that there was no significant difference between the two groups in the characteristics of patients such as age, sex, body weight, past history, operation time, operative method, intraoperative fluid resuscitation, postoperative fluid replacement, urine volume, and blood loss. There was no significant difference in the residual base (standard residual base, strong ion gap and anionic gap) between tissues. Compared with the baseline values, the standard residual bases in these two groups were decreased on T _ 2 T _ 3 and T _ 4; In the laparoscopic pneumoperitoneum group, pH was lower than the reference value due to the increase of PaCO2. However, pH will quickly return to the reference level when the peritoneal carbon dioxide is excreted at the end of laparoscopic surgery. In the open operation group, T 3 and T 4 increased with the increase of lactate and chloride, and the strong ion difference and pH value decreased compared with the reference value. Conclusion: During pneumoperitoneum, the pH of the body decreased with the increase of PaCO2 during aeration, and the PaCO2 decreased after exhaust. The pH will gradually return to normal level. It can be considered that the pH value during laparoscopic surgery is lower, breathing is an important factor. On the other hand. The metabolism of the body one hour after open surgery was also a factor in the decrease of pH value. In the open operation group, it was observed that the increase of lactate was accompanied by strong ion difference and the decrease of pH value. In the open operation group, T3 and T4 lactic acid were significantly increased, which indicated that there was a close correlation between low perfusion and lactic acid accumulation after open pneumoperitoneum.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.2

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