妇科腹腔镜手术CO_2气腹时间与血浆肾素、醛固酮和心钠素浓度变化的相关性分析

Correlation between the time of CO_2 pneumoperitoneum during gynaecological laparoscope surgery and concentration change of plasma rennin activity,aldosterone and atrial natriuretic peptide

目的动态监测妇科腹腔镜手术CO2气腹时不同时间血浆肾素活性(PRA)、醛固酮(ALD)和心钠素(ANP)的变化。方法选择妇科腹腔镜手术患者30例,用放射免疫法(RIA)动态观察CO2气腹前10min(T0)、气腹形成后30min(T1)、60min(T2)及解除气腹后10min(T3)时患者血浆PRA、ALD、ANP含量。结果与T0比较,T1、T2点PRA、ALD均有不同程度的升高,尤以T1点明显(P<0.05);ANP则有不同程度下降,尤以T1点显著(P<0.05)。T3与T0相比,PRA、ALD、ANP均无明显变化(P>0.05)。PRA与ALD随着时间变化表现为T1>T2>T3>T0,而ANP则表现为T0>T3>T2>T1。PRA和ALD随着时间的变化呈正相关(r=0.996,P<0.05),而PRA与ANP则呈负相关(r=-0.981,P<0.05)。结论妇科腹腔镜手术CO2气腹对肾素活性、醛固酮、心钠素有一定影响,高血压、心脏病及内分泌异常者行CO2气腹手术要慎重。

Objective To observe the change of the plasma levels of renin activity（PRA）,aldosterone（ALD） and atrial natriuretic peptide（ANP） at different time during gynaecological laparoscope surgery.Methods The plasma PRA,ALD and ANP levels in 30 patients undergoing gynaecological laparoscope surgery were detected by radioimmunoassay 10 min（T0） before pneumoperitoneum,30 min（T1） and 60 min（T2） after the formation of pneumoperitoneum and 10 min（T3） after the cessation of pneumoperitoneum.Results The plasma PRA and ALD levels at T1 and T2 were both increased relatively compared to T0,especially in T1（P0.05）,while ANP was descend relatively compared to T0,especially in T1（P0.05）.There were no significant differences in PRA,ALD and ANP levels between T0 and T3（P0.05）.The relationships between plasma PRA and ALD levels were T1T2T3T0,while ANP were T0T3T2T1.There was a positive correlation between PRA and ALD at different time points（r=0.996,P0.05）,while a negative correlation between PRA and ANP at different time points（r=-0.981,P0.05）.Conclusion CO2 pneumoperitoneum during gynaecological laparoscope surgery have a certainly effect on plasma PRA,ALD and ANP levels.A prudent policy should be adopted for patients with hypertension,heart disease and endocrine abnormality that required laparoscope surgery with CO2 pneumoperitoneum.