不同气腹压力对腹腔镜胆囊切除术后短期并发症的影响

目的：探讨不同CO2 气腹压力对腹腔镜胆囊切除（LC）术后肝功能、动脉血气及对颈肩部疼痛的影响。方法：选择行择期LC 术患者120 例，随机分为A，B，C 3 组，每组40 例。A 组气腹压力设置为10 mmHg（1 mmHg=0.133 kPa），B 组为12 mmHg，C 组为14 mmHg。对比分析3 组手术前后肝功能、血气指标及术后1~3 d 恶心呕吐、颈肩部疼痛的发生率。结果：术前3 组间各参数比较差异无统计学意义（均P>0.05），但术后3 组间肝功能、血气指标改变及恶心呕吐、颈肩部疼痛的发生率均有明显差异（均P<0.05）。结果显示，气腹压力越大，术后肝功能（AST，ALT，TBIL 升高）和血气指标（PCO2 升高，pH，PO2 下降）变化越明显，且术后颈、肩痛及恶心呕吐发生率越高。结论：气腹压力对LC 术后肝功能，动脉血气，颈，肩痛及恶心呕吐有明显影响，故术中应尽量降低气腹压力。

Impact of different pneumoperitioneum pressures on the short-term complications following laparoscopic cholecystectomy

Objective: To investigate the influences of different pressures of CO2 pneumoperitioneum on liver function,arterial blood gas, and neck or shoulder pain following laparoscopic cholecystectomy (LC).Methods: One hundred and twenty patients scheduled for elective LC were randomly assigned to group A,B and C, with 40 cases in each group. The CO2 pneumoperitoneum pressure was maintained at 10 mmHg ingroup A, 12 mmHg in group B and 14 mmHg in the group C. The liver function and blood gas parametersbefore and after operation, and the incidences of nausea, vomiting, and neck or shoulder pain on the first tothird postoperative day of the three groups were compared and analyzed.Results: The preoperative data among the three groups had no statistical differences (all P>0.05), but theparameters of liver function and arterial blood gas as well as the incidence of nausea, vomiting, and neck orshoulder pain after operation were all significantly different among them (all P<0.05). The results showed thatthe higher the pneumoperitioneum pressure was increased, the more significantly did the parameters of liverfunction (increase of AST, ALT and TBIL) and arterial blood gas (increases of PO2, and decrease of pH andPCO2 ) change, and the higher was the incidence of nausea, vomiting, and neck or shoulder pain.Conclusion: The CO2 pneumoperitioneum pressure has significant impact on incidence of liver functionabnormalities, arterial blood gas derangements, and neck or shoulder pain following LC. Therefore, thepneumoperitioneum pressure should be decreased as low as possible during operation.