腹腔与腹膜后二氧化碳气腹对抗利尿激素、醛固酮和尿量的影响

发布时间：2018-05-17 21:04

本文选题：腹腔气腹 + 腹膜后气腹　；参考：《上海医学》2015年12期

【摘要】：目的观察腹腔和腹膜后二氧化碳(CO_2)气腹时患者抗利尿激素(ADH)、醛固酮(ALD)、尿量、血流动力学指标、呼气末CO_2分压(p_(et)CO_2)和动脉血CO_2分压(p_aCO_2)的变化,为临床麻醉处理提供客观依据。方法选取择期行腹腔镜胆囊切除手术的患者(腹腔镜组)17例,行后腹腔镜肾脏囊肿去顶手术的患者(后腹腔镜组)20例。分别于麻醉前(T_0)、麻醉后气腹前(T_1)、气腹10min(T_2)、气腹30min(T_3)、放气时(T_4)、放气后1h(T_5)各时间点,测定患者的血浆ADH、ALD水平和心率(HR)、收缩压(SBP)、舒张压(DBP)、p_aCO_2、p_(et)CO_2,记录气腹前30min至气腹开始、气腹开始至气腹后30min、放气时至放气后30min、放气后30~60min时患者的尿量。结果两组间患者的气腹时间、气腹压力、术中补液总量的差异均无统计学意义(P值均0.05)。两组各时间点间和两组间ADH和ALD水平的差异均无统计学意义(P值均0.05)。与同组T_1时间点比较,腹腔镜组T_0、T_3、T_5时间点的HR均显著增快(P值均0.05);后腹腔镜组T_3、T_4时间点的HR均显著减慢(P值均0.05),T_5时间点的HR显著增快(P0.05)。腹腔镜组T_2、T_3时间点的HR显著快于后腹腔镜组同时间点(P值均0.05)。与同组T_1时间点比较,腹腔镜组T_0、T_2、T_3、T_4、T_5时间点的SBP和T_0、T_2、T_5时间点的DBP均显著升高(P值均0.05),后腹腔镜组T_0、T_2、T_5时间点的SBP和DBP均显著升高(P值均0.05)。腹腔镜组T_2、T_3、T_4、T_5时间点的SBP和T_2、T_3、T_4时间点的DBP均显著高于后腹腔镜组同时间点(P值均0.05)。腹腔镜组气腹开始至气腹后30min、放气时至放气后30min和后腹腔镜组气腹开始至气腹后30min时的尿量均显著少于同组气腹前30min至气腹开始时(P值均0.05),腹腔镜组放气后30~60min和后腹腔镜组放气时至放气后30min、放气后30~60min时的尿量均显著多于同组气腹开始至气腹后30min时(P值均0.05)。腹腔镜组放气时至放气后30min时的尿量显著少于后腹腔镜组同时间(P0.05)。两组T_2、T_3、T_4时间点的p_(et)CO_2和p_aCO_2均显著高于同组T_1时间点(P值均0.05),腹腔镜组T_4时间点和后腹腔镜组T_3、T_4时间点的p_(et)CO_2和p_aCO_2均显著高于同组T_2时间点(P值均0.05)。腹腔镜组T_3、T_4时间点的p_aCO_2均显著低于后腹腔镜组同时间点(P值均0.05)。结论腹腔和腹膜后气腹对患者血浆ADH和ALD水平均无影响,两者对患者的尿量和血流动力学均有影响,腹腔气腹的影响更大。
[Abstract]:Objective to observe the changes of antidiuretic hormone (ADHN), aldosterone (ALD), urine volume, hemodynamics, CO_2 partial pressure (CO_2) during pneumoperitoneum, and to provide objective basis for clinical anesthetic treatment. Methods Laparoscopic cholecystectomy was performed in 17 patients (laparoscopic group, n = 17) and retroperitoneal laparoscopic renal cyst removal operation (Laparoscopic group, n = 20). At each time point of T _ 0 / T _ 0 before anaesthesia, T _ S _ 1 before anaesthesia, T _ T _ 2 / T _ 2 at 10 min after anesthesia, T _ 3 / T _ 3 at 30 min after pneumoperitoneum, ~ T _ 4 / T _ 4 at exhale and 1 h / T _ 5 after exhale), the plasma ADHHALD level and heart rate HR-HRT, SBP, DBP, DBP _ 2p _ T _ T _ 2 were measured, and 30min before pneumoperitoneum was recorded. The 30min was recorded at the beginning of pneumoperitoneum, and at each time point, the patient's plasma ADHHALD level and heart rate (HRH), systolic pressure (SBP) and diastolic pressure (DBP) were measured. The urine volume of patients with pneumoperitoneum was 30 minutes after pneumoperitoneum, 30 minutes after exhalation and 30 minutes after 30~60min. Results there was no significant difference in pneumoperitoneum time, pneumoperitoneum pressure and intraoperative fluid volume between the two groups (P < 0.05). There was no significant difference in the levels of ADH and ALD between the two groups at each time point and between the two groups (P < 0.05). Compared with the same group at T1 time point, the HR of the Laparoscopic group T0 / T _ 3 / T _ T _ 5 increased significantly (P = 0.05), and the latter group's T _ (3) T _ (4) time point significantly slowed down (P < 0.05) and the T _ (5) / T _ (5) HR increased significantly (P _ (0.05). HR at T _ 2 and T _ 3 in laparoscopic group was significantly faster than that in retroperitoneal group at the same time point (P < 0.05). Compared with the same group at T _ 1, the SBP and the DBP of T _ 0 / T _ 2T _ (5) and T _ (0) T _ (2) T _ (5) in the Laparoscopic group increased significantly, and the SBP and DBP in the later Laparoscopic group were all significantly increased at the point of T _ 0 / T _ 2T _ 5 and T _ 2T _ T _ 5, respectively, and both the SBP and DBP of the laparoscope group were significantly higher than those of the Laparoscopic group at the point of T _ 0 / T _ 2 / T _ 2 / T _ 5 and T _ 0 / T _ 2T _ 5 respectively. The SBP and DBP at the time point of T _ 2T _ 3 / T _ 4 and T _ 2T _ 3 / T _ 4 in the Laparoscopic group were significantly higher than those in the Laparoscopic group at the same time point (P < 0.05). The urine volume of pneumoperitoneum from pneumoperitoneum to postpneumoperitoneum 30 min, pneumoperitoneum from pneumoperitoneum to postpneumoperitoneum 30min from exsufflation to postpneumoperitoneum in laparoscopic group was significantly lower than that from 30min before pneumoperitoneum to pneumoperitoneum at the beginning of pneumoperitoneum in the same group (P < 0.05). The urine volume in retroperitoneal laparoscopy group was significantly higher than that in the same group during exhalation to 30 minutes after exhalation and 30~60min after pneumoperitoneum than that in the same group during pneumoperitoneum and 30min after pneumoperitoneum (P < 0.05). The urine volume of laparoscopy group was significantly lower than that of retroperitoneal laparoscopy group during exhalation and 30min at the same time (P0. 05). The p_(et)CO_2 and p_aCO_2 of the two groups were significantly higher than those of the same group (P = 0.05). The p_(et)CO_2 and p_aCO_2 of the Laparoscopic group at the T4 time point and the retroperitoneal Laparoscopic group were significantly higher than those of the same group at the T2 time point (P < 0.05). The p_aCO_2 of T _ 3 and T _ 4 in the laparoscopic group was significantly lower than that in the retroperitoneal group at the same time point (P < 0.05). Conclusion both peritoneal pneumoperitoneum and retroperitoneal pneumoperitoneum have no effect on plasma ADH and ALD levels. Both of them have an effect on urine volume and hemodynamics, and the effect of abdominal pneumoperitoneum is even greater.
【作者单位】：上海交通大学医学院附属仁济医院麻醉科;
【分类号】：R614

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