动态二氧化碳气腹压力管理应用于肾癌手术患者中的效果分析

Analysis of the effect of dynamic carbon dioxide pneumoperitoneal pressure management in patients with renal cancer surgery

目的探讨动态二氧化碳气腹压力管理应用于肾癌手术患者中的效果。方法选择2020年1月至2022年1月本院收治的行后腹腔镜下肾部分切除术的106例肾癌患者, 随机分为对照组和试验组, 每组各53例。对照组术中维持二氧化碳气腹压力为12 mmHg;试验组基于加速康复外科理念, 根据手术过程动态调节二氧化碳气腹压力。对比两组的肾动脉阻断前后血压、心率、二氧化碳分压(PaCO_(2))、气道压力、呼气末二氧化碳分压(PET)变化及手术前后肾功能、生活质量变化, 记录两组的围手术期指标、并发症发生率。结果两组患者在不同时间段的血压、心率、气道压力、PaCO_(2)及PET水平比较, 差异均无统计学意义(均P>0.05)。试验组的术中出血量、术后引流量、肾动脉阻断时间均短于对照组, 试验组的术后出血发生率低于对照组, 差异均有统计学意义(均P<0.05)。试验组术后第3天的血肌酐(Scr)、尿素氮(BUN)均低于对照组, 差异均有统计学意义(均P<0.05)。试验组术后6个月的生活质量高于对照组, 差异有统计学意义(P<0.05)。结论动态二氧化碳气腹压力管理可有效减少后腹腔镜下肾部分切除术肾癌患者的术中出血量, 减少肾动脉阻断时间, 减少术后引流量, 保护肾功能, 改善生活质量, 同时对循环及呼吸系统无显著影响。

Objective To investigate the effect of dynamic carbon dioxide pneumoperitoneum pressure management in patients with renal cancer surgery.Methods A total of 106 patients with renal cancer who underwent elective retroperitoneal laparoscopic partial nephrectomy who were admitted to our hospital from January 2020 to January 2022 were selected and randomly divided into two groups,with 53 cases in each group.In the control group,the carbon dioxide pneumoperitoneum pressure was maintained at 12 mmHg,while the experimental group was based on the concept of enhanced recovery surgery,and the carbon dioxide pneumoperitoneum pressure was dynamically adjusted according to the operation process.The changes of blood pressure,heart rate,partial pressure of carbon dioxide(PaCO_(2)),airway pressure,partial pressure of end-tidal carbon dioxide(PET),renal function and quality of life before and after operation were compared between the two groups before and after renal artery occlusion,and perioperative indexes and complication rate of the two groups were recorded.Results There were no significant differences in blood pressure,heart rate,airway pressure,PaCO_(2) and PET between the two groups at different time periods(all P>0.05).The intraoperative blood loss,postoperative drainage volume and time of renal artery occlusion in experimental groups were shorter than those in control group,and the incidence of postoperative bleeding in experimental groups was lower than that in control group,with statistical significance(all P<0.05).The serum creatinine(Scr),urea nitrogen(BUN)of experimental groups on the 3rd day after surgery were lower than those of control group,and the differences were statistically significant(all P<0.05).The life quality of experimental group was higher than that of control group 6 months after operation,and the difference was statistically significant(P<0.05).Conclusions Dynamic carbon dioxide pneumoperitoneum pressure management can effectively reduce the intraoperative blood loss,reduce the time of renal artery occlusion,reduce postoperative drainage,protect renal function,and improve the quality of life in patients with renal cancer undergoing posterior laparoscopic partial nephrectomy.Circulatory and respiratory systems were not significantly affected.