不同气腹压力对腹腔镜胆囊切除术患者呼吸循环系统的影响

    Effect of laparoscopic surgery under different pneumoperitoneum pressure on the patient's respiratory and circulatory systems

    • 摘要: 目的: 比较不同气腹压力下腹腔镜胆囊切除术对患者呼吸循环系统的影响.方法: 将72例腹腔镜胆囊切除术的患者随机均分为高气腹压组(HP组,2.0 kPa)和低气腹压组(LP组,1.33 kPa),于气腹前后分别监测呼吸循环系统各项指标及术后并发症,比较2组气腹前后各指标的差异.结果: 气腹后,2组呼吸道压力、呼气末二氧化碳分压、心率、收缩压、平均动脉压均较气腹前显著升高(P< 0.01),且HP组较LP组升高更为明显(P< 0.01),放气5 min 后,LP组均恢复至气腹前水平(P >0.05),而HP组均仍高于气腹前水平(P< 0.01);气腹后,2组胸廓顺应性较气腹前显著降低(P< 0.01),且HP组下降更加显著,放气5 min 后,HP组仍低于气腹前水平(P< 0.01),LP组则恢复正常值.HP组有5例并发症发生.结论: 高气腹压力对患者的呼吸循环系统影响更大,因此腹腔镜手术时,应选择低气腹压进行,并动态监测呼吸循环指标,防止并发症发生.

       

      Abstract: Objective: To compare the effects of laparoscopic surgery under different pneumoperitoneum pressure on the patient's respiratory and circulatory systems.Methods: Seventy-two patients treated with laparoscopic cholecystectomy were randomly divided into high pneumoperitoneum pressure group(HP group,2.0 kPa) and low pneumoperitoneum pressure group(LP group,1.33 kPa).The indicators of respiratory and circulatory systems before and after pneumoperitoneum and postoperative complications between two groups were analyzed.Results: Compared with before pneumoperitoneum,the airway pressure,partial pressure of CO2 in end expiratory,heart rate,systolic blood pressure and mean arterial pressure in two groups significantly increased after pneumoperitoneum(P< 0.01),and the rise degree of which in HP group was significantly higher than that in LP group(P< 0.01).Compared with before pneumoperitoneum,the indicators in LP group came back to normal level(P >0.05),but for the HP group these were still high after 5 min of deflation(P< 0.01).Compared with before pneumoperitoneum,the thoracic compliance in two groups significantly decreased(P< 0.01),and the decline degree of which in HP group was obviously after pneumoperitoneum.Compared with before pneumoperitoneum,the thoracic compliance in LP group improved to normal level(P >0.05),but for the HP group it was still low after 5 min of deflation(P< 0.01).The complications in 5 cases of the HP group were found.Conclusions: The effects of high pneumoperitoneum pressure on the patient's respiratory circulatory systems are great.The laparoscopic surgery should be implemented under low pneumoperitoneum pressure,and the indicators of respiratory and circulatory systems should be dynamically monitored to prevent complications.

       

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