本文選題：腹腔氣腹 + 腹膜后氣腹　； 參考：《上海醫(yī)學(xué)》2015年12期

【摘要】：目的觀察腹腔和腹膜后二氧化碳(CO_2)氣腹時(shí)患者抗利尿激素(ADH)、醛固酮(ALD)、尿量、血流動(dòng)力學(xué)指標(biāo)、呼氣末CO_2分壓(p_(et)CO_2)和動(dòng)脈血CO_2分壓(p_aCO_2)的變化,為臨床麻醉處理提供客觀依據(jù)。方法選取擇期行腹腔鏡膽囊切除手術(shù)的患者(腹腔鏡組)17例,行后腹腔鏡腎臟囊腫去頂手術(shù)的患者(后腹腔鏡組)20例。分別于麻醉前(T_0)、麻醉后氣腹前(T_1)、氣腹10min(T_2)、氣腹30min(T_3)、放氣時(shí)(T_4)、放氣后1h(T_5)各時(shí)間點(diǎn),測(cè)定患者的血漿ADH、ALD水平和心率(HR)、收縮壓(SBP)、舒張壓(DBP)、p_aCO_2、p_(et)CO_2,記錄氣腹前30min至氣腹開(kāi)始、氣腹開(kāi)始至氣腹后30min、放氣時(shí)至放氣后30min、放氣后30~60min時(shí)患者的尿量。結(jié)果兩組間患者的氣腹時(shí)間、氣腹壓力、術(shù)中補(bǔ)液總量的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P值均0.05)。兩組各時(shí)間點(diǎn)間和兩組間ADH和ALD水平的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P值均0.05)。與同組T_1時(shí)間點(diǎn)比較,腹腔鏡組T_0、T_3、T_5時(shí)間點(diǎn)的HR均顯著增快(P值均0.05);后腹腔鏡組T_3、T_4時(shí)間點(diǎn)的HR均顯著減慢(P值均0.05),T_5時(shí)間點(diǎn)的HR顯著增快(P0.05)。腹腔鏡組T_2、T_3時(shí)間點(diǎn)的HR顯著快于后腹腔鏡組同時(shí)間點(diǎn)(P值均0.05)。與同組T_1時(shí)間點(diǎn)比較,腹腔鏡組T_0、T_2、T_3、T_4、T_5時(shí)間點(diǎn)的SBP和T_0、T_2、T_5時(shí)間點(diǎn)的DBP均顯著升高(P值均0.05),后腹腔鏡組T_0、T_2、T_5時(shí)間點(diǎn)的SBP和DBP均顯著升高(P值均0.05)。腹腔鏡組T_2、T_3、T_4、T_5時(shí)間點(diǎn)的SBP和T_2、T_3、T_4時(shí)間點(diǎn)的DBP均顯著高于后腹腔鏡組同時(shí)間點(diǎn)(P值均0.05)。腹腔鏡組氣腹開(kāi)始至氣腹后30min、放氣時(shí)至放氣后30min和后腹腔鏡組氣腹開(kāi)始至氣腹后30min時(shí)的尿量均顯著少于同組氣腹前30min至氣腹開(kāi)始時(shí)(P值均0.05),腹腔鏡組放氣后30~60min和后腹腔鏡組放氣時(shí)至放氣后30min、放氣后30~60min時(shí)的尿量均顯著多于同組氣腹開(kāi)始至氣腹后30min時(shí)(P值均0.05)。腹腔鏡組放氣時(shí)至放氣后30min時(shí)的尿量顯著少于后腹腔鏡組同時(shí)間(P0.05)。兩組T_2、T_3、T_4時(shí)間點(diǎn)的p_(et)CO_2和p_aCO_2均顯著高于同組T_1時(shí)間點(diǎn)(P值均0.05),腹腔鏡組T_4時(shí)間點(diǎn)和后腹腔鏡組T_3、T_4時(shí)間點(diǎn)的p_(et)CO_2和p_aCO_2均顯著高于同組T_2時(shí)間點(diǎn)(P值均0.05)。腹腔鏡組T_3、T_4時(shí)間點(diǎn)的p_aCO_2均顯著低于后腹腔鏡組同時(shí)間點(diǎn)(P值均0.05)。結(jié)論腹腔和腹膜后氣腹對(duì)患者血漿ADH和ALD水平均無(wú)影響,兩者對(duì)患者的尿量和血流動(dòng)力學(xué)均有影響,腹腔氣腹的影響更大。
[Abstract]:Objective to observe the changes of antidiuretic hormone (ADHN), aldosterone (ALD), urine volume, hemodynamics, CO_2 partial pressure (CO_2) during pneumoperitoneum, and to provide objective basis for clinical anesthetic treatment. Methods Laparoscopic cholecystectomy was performed in 17 patients (laparoscopic group, n = 17) and retroperitoneal laparoscopic renal cyst removal operation (Laparoscopic group, n = 20). At each time point of T _ 0 / T _ 0 before anaesthesia, T _ S _ 1 before anaesthesia, T _ T _ 2 / T _ 2 at 10 min after anesthesia, T _ 3 / T _ 3 at 30 min after pneumoperitoneum, ~ T _ 4 / T _ 4 at exhale and 1 h / T _ 5 after exhale), the plasma ADHHALD level and heart rate HR-HRT, SBP, DBP, DBP _ 2p _ T _ T _ 2 were measured, and 30min before pneumoperitoneum was recorded. The 30min was recorded at the beginning of pneumoperitoneum, and at each time point, the patient's plasma ADHHALD level and heart rate (HRH), systolic pressure (SBP) and diastolic pressure (DBP) were measured. The urine volume of patients with pneumoperitoneum was 30 minutes after pneumoperitoneum, 30 minutes after exhalation and 30 minutes after 30~60min. Results there was no significant difference in pneumoperitoneum time, pneumoperitoneum pressure and intraoperative fluid volume between the two groups (P < 0.05). There was no significant difference in the levels of ADH and ALD between the two groups at each time point and between the two groups (P < 0.05). Compared with the same group at T1 time point, the HR of the Laparoscopic group T0 / T _ 3 / T _ T _ 5 increased significantly (P = 0.05), and the latter group's T _ (3) T _ (4) time point significantly slowed down (P < 0.05) and the T _ (5) / T _ (5) HR increased significantly (P _ (0.05). HR at T _ 2 and T _ 3 in laparoscopic group was significantly faster than that in retroperitoneal group at the same time point (P < 0.05). Compared with the same group at T _ 1, the SBP and the DBP of T _ 0 / T _ 2T _ (5) and T _ (0) T _ (2) T _ (5) in the Laparoscopic group increased significantly, and the SBP and DBP in the later Laparoscopic group were all significantly increased at the point of T _ 0 / T _ 2T _ 5 and T _ 2T _ T _ 5, respectively, and both the SBP and DBP of the laparoscope group were significantly higher than those of the Laparoscopic group at the point of T _ 0 / T _ 2 / T _ 2 / T _ 5 and T _ 0 / T _ 2T _ 5 respectively. The SBP and DBP at the time point of T _ 2T _ 3 / T _ 4 and T _ 2T _ 3 / T _ 4 in the Laparoscopic group were significantly higher than those in the Laparoscopic group at the same time point (P < 0.05). The urine volume of pneumoperitoneum from pneumoperitoneum to postpneumoperitoneum 30 min, pneumoperitoneum from pneumoperitoneum to postpneumoperitoneum 30min from exsufflation to postpneumoperitoneum in laparoscopic group was significantly lower than that from 30min before pneumoperitoneum to pneumoperitoneum at the beginning of pneumoperitoneum in the same group (P < 0.05). The urine volume in retroperitoneal laparoscopy group was significantly higher than that in the same group during exhalation to 30 minutes after exhalation and 30~60min after pneumoperitoneum than that in the same group during pneumoperitoneum and 30min after pneumoperitoneum (P < 0.05). The urine volume of laparoscopy group was significantly lower than that of retroperitoneal laparoscopy group during exhalation and 30min at the same time (P0. 05). The p_(et)CO_2 and p_aCO_2 of the two groups were significantly higher than those of the same group (P = 0.05). The p_(et)CO_2 and p_aCO_2 of the Laparoscopic group at the T4 time point and the retroperitoneal Laparoscopic group were significantly higher than those of the same group at the T2 time point (P < 0.05). The p_aCO_2 of T _ 3 and T _ 4 in the laparoscopic group was significantly lower than that in the retroperitoneal group at the same time point (P < 0.05). Conclusion both peritoneal pneumoperitoneum and retroperitoneal pneumoperitoneum have no effect on plasma ADH and ALD levels. Both of them have an effect on urine volume and hemodynamics, and the effect of abdominal pneumoperitoneum is even greater.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院麻醉科;
【分類號(hào)】：R614

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