不同压力二氧化碳气腹对腹腔镜胃癌根治术患者手术效果以及肝肾功能的影响

Influence of different pressure carbon dioxide pneumoperitoneum on surgical effect and liver and kidney function in patients undergoing laparoscopic radical gastrectomy

目的探讨不同压力二氧化碳气腹对腹腔镜胃癌根治术患者手术效果以及肝肾功能的影响。方法选取2016年7月~2018年9月我院收治的60例腹腔镜胃癌根治术患者作为研究对象,按照二氧化碳气腹压力的不同分为观察组、对照1组与对照2组,每组各20例。观察组气腹压力控制为6~8mmHg,对照1组气腹压力控制为9~11mmHg,对照2组气腹压力控制为12~14mmHg。比较三组患者气腹前后的动脉血二氧化碳分压、血氧分压、N-乙酰-β-D-葡萄糖苷酶、胱抑素C、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、肌酐、尿素氮、尿量。结果三组患者气腹前的动脉血二氧化碳分压及血氧分压比较,差异无统计学意义(P>0.05);观察组患者气腹后2h、气腹结束后24h的动脉血二氧化碳分压均低于气腹前、对照1组、对照2组,血氧分压均高于气腹前、对照1组、对照2组,差异有统计学意义(P<0.05);对照1组、对照2组患者气腹后2h、气腹结束后24h的动脉血二氧化碳分压均高于气腹前,血氧分压均低于气腹前,差异有统计学意义(P<0.05)。三组患者气腹前的N-乙酰-β-D-葡萄糖苷酶、胱抑素C水平比较,差异无统计学意义(P>0.05);三组患者气腹后2h、气腹结束后24h的N-乙酰-β-D-葡萄糖苷酶、胱抑素C水平均低于气腹前,差异有统计学意义(P<0.05);观察组患者气腹后2h、气腹结束后24h的N-乙酰-β-D-葡萄糖苷酶、胱抑素C水平均低于对照1组、对照2组,差异有统计学意义(P<0.05)。三组患者气腹前、气腹后2h、气腹结束后24h的丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、肌酐、尿素氮及尿量比较,差异无统计学意义(P>0.05);三组患者气腹后2h、气腹结束后24h的丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、尿量均高于气腹前,肌酐、尿素氮均低于气腹前,差异有统计学意义(P<0.05)。结论二氧化碳气腹压力控制为6~8mmHg最佳,可在减轻对肝肾功能损伤的同时提高手术治疗效果。

Objective To investigate the influence of different pressure carbon dioxide pneumoperitoneum on surgical effect and liver and kidney function in patients undergoing laparoscopic radical gastrectomy.Methods A total of 60 patients with laparoscopic radical gastrectomy admitted to our hospital from July 2016 to September 2018 were selected as the study subjects.According to the difference of carbon dioxide pneumoperitoneum pressure,they were divided into observation group,control group 1 and control group 2,with 20 cases in each group.The control of pneumoperitoneum pressure was 6-8 mmHg in the observation group,9-11 mmHg in the control group 1 and 12-14 mmHg in the control group 2.The arterial blood carbon dioxide partial pressure,blood oxygen partial pressure,N-acetyl-β-D-glucosidase,cystatin C,alanine aminotransferase,aspartate aminotransferase before and after pneumoperitoneum in three groups of patients,creatinine,urea nitrogen,urine volume were compared among the three groups before and after pneumoperitoneum.Results There were no significant differences in arterial blood carbon dioxide partial pressure and blood oxygen partial pressure among the three groups before pneumoperitoneum (P>0.05).The arterial blood carbon dioxide partial pressure in the observation group at 2 h after pneumoperitoneum and 24 h after end of pneumoperitoneum was lower than that before pneumoperitoneum,in control group 1 and in control group 2,and the blood oxygen partial pressure was higher than that before pneumoperitoneum,in control group 1 and in control group 2,with statistically significant differences (P<0.05).The arterial blood carbon dioxide partial pressure of the control group 1 and the control group 2 at 2 h after pneumoperitoneum and 24 h after end of pneumoperitoneum was higher than that before pneumoperitoneum,the blood oxygen partial pressure was lower than that before pneumoperitoneum,and the differences were statistically significant (P<0.05).There were no significant differences in the levels of N-acetyl-β-D-glucosidase and cystatin C among the three groups before pneumoperitoneum (P>0.05).The levels of N-acetyl-β-D-glucosidase and cystatin C in the three groups at 2 h after pneumoperitoneum and 24 h after end of pneumoperitoneum were lower than those before pneumoperitoneum,and the differences were statistically significant (P<0.05).The levels of N-acetyl-β-D-glucosidase and cystatin C in the observation group at 2 h after pneumoperitoneum and 24 h after end of pneumoperitoneum were lower than those in control group 1 and in control group 2,and the differences were statistically significant (P<0.05).There were no significant differences in alanine aminotransferase,aspartate aminotransferase,creatinine,urea nitrogen and urine volume among the three groups before pneumoperitoneum,2 h after pneumoperitoneum,and 24 h after end of pneumoperitoneum (P>0.05).The alanine aminotransferase,aspartate aminotransferase,and urine volume of the three groups at 2 h after pneumoperitoneum and 24 h after end of pneumoperitoneum were higher than those before pneumoperitoneum,the creatinine and urea nitrogen were lower than those before pneumoperitoneum,and the differences were statistically significant (P<0.05).Conclusion The optimal control of carbon dioxide pneumoperitoneum is 6-8 mmHg,which can improve the surgical effect while reducing liver and kidney function damage.