不同气腹压对行腹腔镜胆囊切除术合并乙型病毒性肝炎患者手术期血流动力学及术后肝功能的影响

Effects of Different Pneumoperitoneum Pressures on Perioperative Hemodynamics and Postoperative Liver Function Recovery in Patients Undergoing Laparoscopic Cholecystectomy Combined with Viral Hepatitis Type B

目的探析不同气腹压对行腹腔镜胆囊切除术合并乙型病毒性肝炎患者手术期血流动力学及术后肝功能的影响。方法选择2013年4月—2015年10月收治的93例行腹腔镜胆囊切除术合并乙型病毒性肝炎患者展开回顾性分析。根据手术时气腹压力的不同分为低气腹压组(气腹压力8~12 mm Hg,n=50)及高气腹压组(气腹压力13~15 mm Hg,n=43)。比较两组手术成功率、手术期血流动力学指标、手术前后肝功能指标及并发症发生率。结果两组手术成功率比较差异无统计学意义(P>0.05)。建立气腹10 min和25 min,两组动脉血二氧化碳分压、平均动脉压和中心静脉压均高于气腹前5 min(P<0.05),低气腹压组低于高气腹压组(P<0.05)。术后1 d和3 d,两组总胆红素、丙氨酸转氨酶和天冬氨酸转氨酶均高于术前(P<0.05),且低气腹压组低于高气腹压组(P<0.05)。低气腹压组并发症发生率低于高气腹压组(P<0.05)。结论腹腔镜胆囊切除术合并乙型病毒性肝炎患者本身即存在肝功能损伤,且耐受力减弱。故尽量减小术中气腹压,于患者有益。

Objective To investigate effects of different pneumoperitoneum pressures on perioperative hemody- namics and postoperative liver function recovery in patients undergoing laparosc0Pic cholecystectomy combined with viral hepatitis type B. Methods clinical data of 93 patients undergoing laparoscopic cholecystectomy combined with viral hepatitis type B admitted during April 2015 and October 2013 was retrospectively analyzed, and the patients were divided into low pneumoperitoneum pressure group （8-12 mmHg pneumoperitoneum pressure, n = 50） and high pneumoperitone- um pressure group （13-15 mmHg pneumoperitoneum pressure, n = 43） according to different surgical pneumoperitoneum pressures. Operation success rate, hemodynamic indexes during operation, liver function indexes and incidence rate of complications before and after operation were compared between the two groups. Results There was no significant differ- ence in success rate of operation between the two groups （P 〉 O. 05 ）. Values of arterial carbon dioxide tension （PaCO2 ） , mean arterial pressure and central venous pressure at 10 min and 25 rain after pneumoperitoneum establish- ment were significantly higher than those at 5 rain before pneumoperitoneum establishment in two groups （P 〈 O. 05 ） , and the values in low pneumopcritoneum pressure group were significantly lower than those in high pneumoperitoneum pressure group （ P 〈 O. 05 ）. Total bilirubin, alanine aminotransferase and aspartate aminotransferase levels at 1 d and 3 d after surgery were significantly higher than those before surgery in two groups （ P 〈 0.05 ）, and the levels in low pneumoperito- neum pressure group were significantly lower than those in high pneumoperitoneum pressure group （ P 〈 0.05 ） ： The inci- dence rate of complications in low pneum0Peritoneum pressure group was significantly lower than that in high pneumoper- itoneum pressure group （P 〈 O. 05 ）. Conclusion Patients undergoing laparoscopic cholecystectomy combined with viral hepatitis type have liver damage in themselves and poor tolerance. It is beneficial for patients to reduce the intraoperative pneumoperitoneum pressure.