不同CO_2气腹压力对腹腔镜下治疗胃癌的临床效果的影响

目的考察不同CO_2气腹压力对腹腔镜下治疗胃癌的临床效果的影响。方法选取2015年3月至2016年3月行腹腔镜下胃癌根治术的患者87例进行前瞻性研究。根据患者在腹腔镜手术中CO_2的气腹压力,随机分为低CO_2气腹组(7~9 mm Hg,29例)、中CO_2气腹组(10~12 mm Hg,29例)和高CO_2气腹组(13~15 mm Hg,29例),分别监测患者在气腹前(T0)、气腹后1 h(T1)、气腹后2 h(T2)和气腹停止后1 h(T3)各时间点三组患者的平均动脉压(MAP)、心率(HR)、酸碱度(pH)、动脉血二氧化碳分压(Pa CO_2)、动脉血氧分压(Pa O_2)、胱抑素C(Cys-C)和尿量。采用SPSS 17.0版软件对所有数据进行分析,术中相关指标及各时间点HR、MAP、pH、Pa CO_2、Pa O_2、Cys-C和尿量的变化,均以均数±标准差(x珋±s)的形式表示,组间比较采用t检验;计数资料采用χ2检验;以P0.05表示差异有统计学意义。结果与各组T0时间点和低CO_2气腹组相比,中、高CO_2气腹组T1至T3时间点的HR、MAP、Pa CO_2和Cys-C均显著升高,而尿量显著降低,差异具有统计学意义P0.05。结论低CO_2气腹压力对行腹腔镜治疗胃癌患者术中的循环和呼吸系统影响最小,并且可显著减轻气腹压力对肾功能的损伤,临床效果好、可推广应用于临床。

Influence of different CO2 pneumoperitoneum pressure on the clinical effect treated gastric carcinoma undergoing laparoscope

Objective To investigate the influence of different CO 2 pneumoperitoneum pressure on the clinical effect treated gastric carcinoma undergoing laparoscope . Methods 87 cases radical gastrectomy patients undergoing laparoscope from March 2015 to March 2016 in our hospital conducted a prospective study.According to the CO2 pneumoperitoneum pressure undergoing laparoscope , random divided into low pneumoperitoneum group (7 -9 mmHg, 29 cases), middle pneumoperitoneum group (10-12 mmHg, 29 cases ) and high pneumoperitoneum group ( 13 -15 mmHg, 29 cases ), respectivelymonitored the MAP, HR, pH, PaCO2 , PaO2 ,Cys-C and urine volumebefore pneumoperitoneum (T0), after pneumoperitoneum 1 h (T1), 2 h (T2) and after stop pneumoperitoneum 1 h (T3) of the three groups.Statistical analysis were performed by using SPSS 17.0 software, intraoperative related indicators and the change of MAP, HR, pH, PaCO2, PaO2,Cys-C and urine volume of each time were presented as and examined by using t test; enumeration data was examined by chi square test .A P value of <0.05 was considered as significant difference .Results Compared with the T 0 timing of each group and the low pneumoperitoneum group, the HR, MAP, PaCO2 and Cys-C at T1 to T3 timing of middle and high pneumoperitoneum group both significantly increased , but the urine volume significantly decreased , with statistical significance (P<0.05). Conclusion Low CO2 pneumoperitoneum pressure of laparoscopic surgical treatment of gastric carcinoma patients has minimal impact with the circulation and respiratory system, and can significantly reduce renal damage , clinical effect is good , can be applied in clinical .