CO_(2)气腹压力预设阈值设定方案构建对腹腔镜手术患者血流动力学及并发症的影响

Influence of CO_(2)pneumoperitoneum pressure setting scheme construction on hemodynamics and complications in patients undergoing laparoscopic surgery

目的探讨腹腔镜下CO_(2)气腹压力预设阈值设定方案的构建,及对术中血流动力学和并发症的影响。方法选择2020年3月-2021年5月本院收治的腹腔镜手术患者616例为研究对象,采用回顾性病例研究及现况调查相结合方式,设计2版调查表,进行3轮调研,符合组间匹配原则下分为观察组283例(其中肝胆外科124例、妇科133例、胃肠外科26例)和对照组333例(肝胆外科139例、妇科159例、胃肠外科35例)。比较两组患者气管插管后5 min(T0)、手术开始(T1)、手术开始0.5 h(T2)、手术结束(T3)四个时点的收缩压(SBP)、舒张压(DBP)、心率(HR)及呼末二氧化碳分压(ETCO_(2))指标变化值;两组患者术后发生皮下气肿及术后不良反应例数。经汇总分析整理,构建一套实用的各类腔镜手术的CO_(2)气腹压力值的设定指标。结果横向比较:T1时点:两组患者SBP、DBP、HR值较T0时点降低(P<0.05);T2时点:观察组DBP值较T1时点上升(P<0.05);T3时点:两组SBP值、观察组DBP值及HR值较T2时点上升(P<0.05);两组ETCO_(2)值各时点较上个时点均上升(P<0.05)。纵向比较:两组患者T0、T1、T2各时点HR值有变化(P<0.05);两组患者T3时点SBP、DBP有变化(P<0.05)。观察组患者术后皮下气肿、恶心、呕吐、苏醒期躁动及肩痛的发生率均低于对照组(P<0.05)。结论采用低气腹压力,有效提升苏醒质量,减少术后不良反应发生率。构建手术外科细化标准的CO_(2)气腹压力阈值,实施动态精准预设为术中患者血流动力学改变提供依据。

Objective To explore the establishment of the preset range of CO_(2)pneumoperitoneum pressure under laparoscopy and its influence on intraoperative hemodynamics and complications.Methods A retrospective case study and a current situation survey were combined to analyze 616 laparoscopic surgery patients admitted to our hospital from March 2020 to May 2021.Two versions of a questionnaire were designed,and three rounds of surveys were conducted.Patients were divided into an observation group(n=283,including 124 from hepatobiliary surgery,133 from gynecology,and 26 from gastrointestinal surgery)and a control group(n=333,including 139 from hepatobiliary surgery,159 from gynecology,and 35 from gastrointestinal surgery),following matching principles.Systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),and end-tidal carbon dioxide pressure(ETCO_(2))at 5 minutes after intubation(T0),at the start of surgery(T1),0.5 hours after the start of surgery(T2),and at the end of surgery(T3)were compared between the groups.Additionally,the incidence of postoperative subcutaneous emphysema and adverse reactions was compared.A practical set of CO_(2)pneumoperitoneum pressure setting indicators for various endoscopic surgeries was established through summary and analysis.Results In the horizontal comparison,at T1,SBP,DBP,and HR in both groups were lower than at T0(P<0.05);at T2,DBP in the observation group increased compared to T1(P<0.05);at T3,SBP and DBP in both groups and DBP and HR in the observation group increased compared to T2(P<0.05).ETCO_(2)values in both groups increased at each time point compared to the previous one(P<0.05).In the longitudinal comparison,HR values at T0,T1,and T2 in both groups changed(P<0.05);at T3,SBP and DBP in both groups changed(P<0.05).The incidence of postoperative subcutaneous emphysema,nausea,vomiting,emergence agitation,and shoulder pain in the observation group was lower than in the control group(P<0.05).Conclusions The use of low pneumoperitoneum pressure can effectively improve the quality of recovery and reduce the incidence of postoperative adverse reactions.The establishment of a detailed standard for surgical CO_(2)pneumoperitoneum pressure setting provides a basis for dynamic and precise presetting,which in turn provides a reference for changes in patients'hemodynamics during surgery.