机器人辅助妇科手术术中气腹对患者肝肾功能影响的初步临床研究

Pilot Study on the Effect of Pneumoperitoneum on Hepatic and Renal Function during Robotic Laparoscopic Gynecologic Surgery

目的:研究机器人辅助妇科手术中气腹对术者肝肾功能的影响。方法:择期开腹妇科手术和机器人辅助妇科手术患者各20例,18-65岁,体重指数18-30,美国麻醉医师协会分级1-2级。手术均在全身麻醉下进行。采用丙泊酚(1.5-2 mg/kg)和芬太尼(2-4μg/kg)进行全麻诱导。麻醉维持采用七氟烷和瑞芬太尼。术中维持Narcotrend指数于40-60。分别于手术开始前和结束后30 min抽取静脉血,测定血谷丙转氨酶、谷草转氨酶、尿素氮和肌酐水平并分析其变化。结果:与开腹手术相比,机器人辅助妇科手术气腹后血谷丙转氨酶、谷草转氨酶、尿素氮和肌酐的升高更为明显(P均<0.05)。结论:机器人辅助妇科手术中长时间气腹可能引起肝肾功能的异常。

Objective： To compare the change of hepatic and renal function after open or robotic laparoscopic gynecologic surgery. Methods： Patients scheduled for open or robotic laparoscopic gynecologic surgery were involved in this study （n=20）. Inclusion criteria included age between 18-30 yr, BMI between 18-30 kg/cm^2 and ASA status 1-2. Anesthesia induction was done with propofol （ 1.5-2 mg/kg）and fentanyl （2-4 μg/kg）. Anesthesia was maintained by sevoflurane and remifentanil. Narcotrend index was maintained at 40-60 during surgery. Venous blood sample was collected before and at 30min after surgery for assay of Alanine transaminase （ALT）, Aspartate transaminase （AST）, Blood urea nitrogen （BUN） and Creatinine （Cr）. Results： Compared with patients undergoing open surgery, those undergoing robotic laparoscopic gynecologic surgery showed significant change of ALT, AST, BUN and Cr. Conclusion： Long duration of pneumoperitoneum during robotic laparoscopic gynecologic surgery could lead to abnormal hepatic and renal function. However, the clinical significance of this change is still unclear.