不同体位腹腔镜手术时血浆心钠素、血管紧张素Ⅱ的变化

Changes of plasma atrial natriuretic polypeptide and angiotensin Ⅱ during laparoscopic operation with different posture

目的观察不同体位腹腔镜手术时血浆心钠素（ANP）和血管紧张素Ⅱ（AngⅡ）的变化，并探讨其临床意义。方法择期腹腔镜手术患者40例，按需分为两组：A组20例，行头低足高体位；B组20例，行头高足低体位。两组均采用全身静脉麻醉。术中维持气腹压14mmHg（1mmHg=0．133kPa）。分别于气腹前（T1），气腹后调整至手术所需体位10rain（T2）、20min（T3）及解除气腹后5min（T4）经中心静脉抽取静脉血，放免法测定血浆中ANP和AngⅡ的含量。结果A组ANP在T2时较T1略升高，至13时显著增高（P〈0．05）；两组间T2、T3同时点比较差异有统计学意义（P〈0．05）。AngII在两组他、T3时点较T1明显升高（P〈0．01）；组间比较差异无统计学意义（P〉0．05）。结论腹腔镜手术时不同体位能够对ANP产生明显影响，对AngⅡ则无明显影响。

Objective To observe the effects of different posture on plasma ANP and Angll during laparoscopy. Methods Forty patients, ASA class Ⅰ or Ⅱ, scheduled for elective laparoscopy surgery under general anesthesia were included in this study. The patients were randomly divided into two groups according to their posture during laparoscopy（20 cases for each group）. The patients in group A were arranged in a head-down tilt position and in group B in a head-up tilt position according to the requirement of the operation. Blood samples were taken from central venous at four time points of before pneumoperitoneum （ T1 ）, after 10 minutes （ T2 ） and 20 mintues （ T3 ） when the patients were arranged in the different operation-needed position with a stable pneumoperitoneum pressure of 14 mm Hg （1 mm. Hg = 0. 133 kPa）, and at 5 minutes（T4） after deflation of pneumoperitoneum when the patients returned to supine position. The plasma ANP and Ang Ⅱ were assessed by radioimmunoassay. Results The plasma level of ANP in group A was higher at T2 than that at T1, and it was significantly higher at T3 than that at T1 （P 〈 0.05 ）. ANP level was significantly higher in group A than that in group B at the same time points of T2 and T3 （P 〈 0. 05）. Ang Ⅱ levels at T2 and T3 in both groups were significantly higher than that at T1 （P 〈 0. 01 ）, but there was no significant difference between the two groups （P 〉 0. 05）. Conclusions The posture may have obvious effect on plasma ANP during pneumoperitoneum. It may have no obvious effect on plasma Ang Ⅱ.