不同压力CO_2气腹对妇科腹腔镜手术患者术后胃肠道功能的影响

Effect of different pressure CO_2 pneumoperitoneum on postoperative gastroeuteric function in female patients undergoing gynecological laparoscopic surgery

目的探讨不同压力CO_2气腹对妇科腹腔镜手术患者术后胃肠道功能的影响。方法择期行妇科腹腔镜手术患者120例,年龄30~60岁,ASAⅠ或Ⅱ级。采用随机数字表法将患者分为三组,每组40例。L组、M组和H组气腹压力分别为6~8、9~11和12~14 mm Hg。所有患者检测术前6 h、术后6 h检测患者空腹血清D-乳酸含量,记录麻醉诱导前(T_1)、气腹前(T_2)、气腹后1 h(T_3)、2 h(T_4)及停止气腹后1 h(T_5)的动脉血pH、PaCO_2和PaO_2。记录术中气腹时间,术后首次排气时间、进食时间、排便时间、术后住院时间。结果三组患者术后6 h的血清D-乳酸含量较术前6h明显升高(P<0.05);与L组比较,M组和H组术后6 h的血清D-乳酸含量明显升高(P<0.05)。三组患者PaO_2差异无统计学意义。与L组比较,T_3、T_4时M组和H组pH明显降低(P<0.05);T_3~T_5时M组和H组PaCO_2明显升高(P<0.05)。与L组比较,M组和H组的患者首次排气时间、进食时间、排便时间及术后住院时间明显延长(P<0.05)。结论低CO_2压力气腹可减轻CO_2气腹对患者胃肠道功能的损伤,有利于患者术后早期胃肠道功能的恢复。

Objective To investigate the effect of different pressure CO2 pneumoperitoneum on postoperative gastroeuteric function in female patients undergoing gynecological laparoscopic surgery. Methods A total of 120 female patients,aged 30-60 years,ASA physical status Ⅰ or Ⅱ,scheduled for elective gynecological laparoscopic surgery were randomly into three groups（ n = 40 in each）. The pressure of CO2 pneumoperitoneum were set at 6-8,9-11 and 12-14 mm Hg in group L,group M and groupH,respectively. All patients were detected on an empty stomach of serum concentrations of D-lactic acid 6 hours before operation and after opration. In addition,pH,PaCO2 and PaO2 were recorded before anesthesia（ T1）,before pneumoperitoneum（ T2）,1 hour after pneumoperitoneum（ T3） 2 hours after pneumoperitoneum（ T4） and 1 hour（ T5） after stopping pneumoperitoneum. The time of pneumoperitoneum,the time of first flatus,intake and defecation,length of primary hospital stays after operation were recorded. Results Compared with 6 hours before operation,the serum concentrations of D-lactic acid were obviously increased at postoperative 6 hours in all groups（ P〈0. 05）. Compared with group L,the serum concentrations of D-lactic acid at 6 hours after operation were obviously increased in group M and groupH（ P〈0. 05）. PaO2 in three groups was not different at T1-T5. Compared with group L,pH at T3,T4 was significantly decreased in group M and groupH（ P〈0. 05）. Compared with group L,PaCO2 was significantly increased at T3-T5 in group M and groupH（ P〈0. 05）. Compared with group L,the time of first flatus,intake and defecation,length of primary hospital stays after operation were obviously delayed in group M and groupH（ P〈0. 05）.Conclusion The low pressure of CO2 pneumoperitoneum can reduce the damage of CO2 pneumoperitoneum on postoperative gastroeuteric function and avail the recovery of parents＇ postoperative gastroeutericfunction in female patients undergoing gynecological laparoscopic surgery.