腹腔镜胆囊切除术中CO_2气腹对老年患者肝功能的影响

目的观察腹腔镜胆囊切除术(LC)中CO2气腹对老年患者肝功能的影响。方法选择60~73岁ASAⅠ或Ⅱ级择期行LC患者52例,随机分成两组各26例:L组采用低气腹压力9±1 mmHg;S组采用标准气腹压力15±1mmHg;分别于术前24 h(T1)及术后2 h(T2)、24 h(T3)、72 h(T4)抽取外周静脉血送检肝功能,检测记录各项指标进行统计学处理。结果 L组术后2 h、24 h的丙氨酸氨基转移酶(ALT)、门冬氨酸转移酶(AST)均较术前升高(P0.05);S组术后2 h、24 h的ALT、AST、γ-谷氨酸转肽酶(GGT)、乳酸脱氢酶(LDH)与L组比较升高更显著(P0.05);两组各指标均于72 h趋于术前水平。结论老年患者在LC中CO2气腹可引起术后一过性肝功能异常,采取低气腹压有利于保护肝功能。

Study on effect of carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy on liver function in elderly patients.

Objective To observe the effect of carbon dioxide pneumoperitoneum on hepatic function in elderly patients undergoing lapa- roscopic cholecystectomy. Methods Fifty - two patients with ASA Ⅰ or Ⅱ , aged 60 - 73 years, underwent laparoscopic cholecystectomy were ran- domly divided into two groups （n = 26 each） ： low pneumoperitoneal pressure group （group L） with pressure at 9 ±1 mmHg（ group L）and stand- ard pneumoperitoneum pressure group （ group S） with pressure at 15 - 1 mmHg. The indexes of liver function were measured and recorded in 24 h before operation and 2, 24 and 72 hours after operation. Results The serum levels of ALT and AST in 2 h and 24 h after surgery in group L were higher than preoperative figures（ P 〈0.05）. In comparison with group L, ALT, AST, GGT and LDH in 2 h and 24 h after surgery in group S were significantly elevated（ P 〈 0.05 ）. The indexes of these two groups were returned to preoperative level in 72 h after surgery. Conclusion Carbon dioxide pneumoperitoneum can cause transient abnormality of liver function in elderly patients undergoing laparoseopic cholecystectomy, and low pneumoperitoneum pressure is beneficial to protect liver function.