二氧化碳气腹对腹腔镜手术患者心肌酶谱影响的临床分析

Clinical analysis of myocardial enzymes in laparoscopic surgical patients during carbon dioxide pneumoperitoneum

目的：探讨腹腔镜手术二氧化碳（CO2）气腹对患者心肌酶谱影响，以减少和预防并发症，提高腹腔镜手术的安全性。方法选择我市区2009年5月～2012年10月腹腔患者361例。CO2气腹前、气腹15、40min、术后48h分别监测患者静脉血肌酸激酶同工酶（CK-MB）、肌钙蛋白（TnT）、B型脑钠肽（BNP）、乳酸脱氢酶（LDH）、磷酸肌酸激酶（CK）的变化，分析其临床意义及预防对策。结果建立CO2气腹前（T0），LDH（88.90±33.40）U/L、CK （34.50±16.10）U/L、CK-MB（0.06±0.01）ng/mL、TnT（18.40±3.40）pg/mL和BNP（128.60±45.60）U/L都在正常范围；CO2气腹15min（T1），LDH、CK、CK-MB、TnI及BNP较气腹前无明显变化（P＞0.05）；CO2气腹40min（T2）， LDH（123.00±33.60）U/L、CK（120.00±17.80）U/L、CK-MB（172.00±38.80）U/L较气腹前明显升高（P＜0.05）；术后48h（T3）较气腹前无明显变化（P＞0.05）。结论腹腔镜手术建立CO2气腹时可导致心肌酶升高，心肌代谢出现暂时异常，但腹腔镜术后2d内可恢复正常。腹腔镜手术对心肌酶谱无明显影响，是一种安全有效的手术方法。

Objective To explore the effect of myocardial enzymes on laparoscopic surgical patients during carbon dioxide（CO2） pneumoperitoneum,reduce and prevent the complications,therefore,improve the safety of laparoscopic surgery. Methods Three hundred and sixty one patients undergoing laparoscopic surgical during May 2009 and October 2012 were taken the related laboratory tests. The patients received laparoscopic surgery under CO2 pneumoperitoneum during surgery.LDH,CK,CK-MB,TnT and BNP were recorded at four time points of before insufflations（T0）,CO2 insufflation for 15 min（T1）,40 min（T2） and after surgery for 48 hour（T3）.Meanwhile,the data were analyzed and preventive measures were taken. Results LDH （88.90±33.40）U/L,CK （34.50±16.10）U/L,CK-MB （0.06±0.01）ng/ml,TnT （18.40±3.40）pg/mL and BNP （128.60±45.60）U/L are in the normal range at T0. There were no significant difference between T0 and T1 in LDH,CK,CK-MB,TnT and BNP（P〉0.05）. There were significant difference between T1 and T2 in LDH （123.00±33.60）U/L,CK （120.00±17.80）U/L and CK-MB （172.00±38.80） U/L（P 0.05）. Conclusion It can lead to temporary elevated cardiac enzymes in laparoscopic surgery during CO2 pneumoperitoneum,but return to normal within two days. Laparoscopic surgery had no significant effecst on myocardial enzymes,is a safe and effective surgical method.