胃癌腹腔镜手术与开放术酸碱变化的对比分析

发布时间：2018-01-29 19:21

本文关键词： 开放手术腹腔镜气腹术斯图尔特 pH PaCO_2 酸碱平衡强离子间隙非挥发性弱酸总和　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：腹腔镜外科手术中二氧化碳的充入及排出会影响机体内酸碱平衡,此项研究的目的是借助彼得·斯图尔特的方法探究腹腔镜手术机体内酸碱平衡的变化,并与开放手术进行对比分析。方法：选取山东大学附属省立医院胃肠外科100个需行胃肠外科手术治疗的病人,随机分成腹腔镜手术组(n=50)及开放手术组(n=50)。酸碱相关参数测定分别在四个时间点进行：T1：麻醉诱导后10分钟；T2：根据分组腹膜打开或气腹术开始后1小时；T3：手术结束时；T4：手术结束后1小时。最后,整理所得资料,建立数据库,应用SPSS19.0统计分析软件包对数据进行统计分析,病人的特点用Mann-Whitney U检验或适当的情况用Fisher精确检验进行比较,所有测量和计算数据的分布是由单样本柯尔莫哥洛夫-斯米尔诺夫检验(Kolmogorov-Smirnov检验)进行检验,对于其他组内变量和数据进行方差分析,运用t检验以比较组间差异。P值取0.05为显著性标准。结果：两组数据统计分析后显示两组间病人特点如年龄、性别、体重、既往史、手术时间、手术方式、术中补液、术后补液、尿量、失血量没有显著性差异；组织间液的剩余碱(标准剩余碱)、强离子间隙、阴离子间隙也没有显著性差异；与基准值相比较,这两组的标准剩余碱在T2、T3和T4上都是降低的；在腹腔镜气腹手术组的T2,鉴于PaCO2的升高使得pH较基准值降低,但是当腹腔镜手术结束腹膜腔内二氧化碳被排出后pH值会迅速恢复到基准值水平；在开放手术组的T3和T4,伴随着乳酸盐和氯化物的升高,明显的强离子差及pH较基准值降低。结论：在气腹术期间机体内pH会随着充气时PaCO2的升高而降低,当排气后PaCO2随之降低,pH也会逐渐恢复到正常水平。可以认为腹腔镜手术期间的pH值降低,呼吸是一个重要的因素。另一方面,开放手术后一个小时机体的代谢也是其pH值降低的一个因素。在开放手术组可以观察到乳酸盐的升高伴随明显的强离子差及pH降低,而腹腔镜气腹术组没有出现相应的情况。开放手术组中T3和T4乳酸是显著升高的,这表明了开放后机体低灌注,乳酸积累密切相关。
[Abstract]:Objective: The aim of this study is to explore the changes of acid-base balance in laparoscopic surgery with the help of Peter Stewart's method. And compared with open surgery. Methods: A total of 100 patients with gastrointestinal surgery in the provincial hospital affiliated to Shandong University were selected. The patients were randomly divided into two groups: the laparoscopic group (n = 50) and the open group (n = 50). The acid-base related parameters were measured at four time points: 10 minutes after anesthesia induction; T2: according to the group of peritoneal opening or pneumoperitoneum 1 hour after the beginning; T3: at the end of the operation; T4: one hour after the operation. Finally, the data were sorted out, the database was established, and the data were analyzed by SPSS19.0 software package. The characteristics of the patient were compared with Mann-Whitney U test or, where appropriate, with Fisher precise test. The distribution of all the measured and calculated data was tested by a single sample Colmogorov-Smirnov test by the Kolmogorov-Smirnov test. For the variance analysis of variables and data in other groups, t test was used to compare the difference between groups. P value was 0.05 as the significant standard. Results: Statistical analysis of the two groups showed that there was no significant difference between the two groups in the characteristics of patients such as age, sex, body weight, past history, operation time, operative method, intraoperative fluid resuscitation, postoperative fluid replacement, urine volume, and blood loss. There was no significant difference in the residual base (standard residual base, strong ion gap and anionic gap) between tissues. Compared with the baseline values, the standard residual bases in these two groups were decreased on T _ 2 T _ 3 and T _ 4; In the laparoscopic pneumoperitoneum group, pH was lower than the reference value due to the increase of PaCO2. However, pH will quickly return to the reference level when the peritoneal carbon dioxide is excreted at the end of laparoscopic surgery. In the open operation group, T 3 and T 4 increased with the increase of lactate and chloride, and the strong ion difference and pH value decreased compared with the reference value. Conclusion: During pneumoperitoneum, the pH of the body decreased with the increase of PaCO2 during aeration, and the PaCO2 decreased after exhaust. The pH will gradually return to normal level. It can be considered that the pH value during laparoscopic surgery is lower, breathing is an important factor. On the other hand. The metabolism of the body one hour after open surgery was also a factor in the decrease of pH value. In the open operation group, it was observed that the increase of lactate was accompanied by strong ion difference and the decrease of pH value. In the open operation group, T3 and T4 lactic acid were significantly increased, which indicated that there was a close correlation between low perfusion and lactic acid accumulation after open pneumoperitoneum.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.2

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