气腹对腹腔镜胆囊切除患者血压的影响分析

目的:探讨气腹对腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者血压的影响。方法:选取2010年1月至2013年1月87例行LC的患者,根据患者血压状况分为3组,每组29例。A组有高血压病史但术前未进行规律治疗,入院时血压符合高血压病诊断;B组有高血压病史并规律治疗,入院时血压正常;C组无高血压病史。对比3组患者气腹前(T1)、气腹后1 min(T2)、5 min(T3)、10 min(T4)、20 min(T5)及气腹解除后10 min(T6)的平均动脉压(mean arterial pressure,MAP)、收缩压(systolic blood pressure,SBP)及舒张压(diastolic blood pressure,DBP)。结果:T1、T2时,3组患者MAP、SBP差异无统计学意义(P>0.05);T3、T4、T5、T6时,A组患者MAP、SBP均高于B、C组,各期差异均有统计学意义(P<0.05),B、C组两组间差异无统计学意义(P>0.05)。T1时,3组患者DBP差异无统计学意义(P>0.05);T2、T3、T4、T5、T6时,A组患者DBP均高于B、C组,各期差异均有统计学意义(P<0.05);B、C两组间差异无统计学意义(P>0.05)。结论:气腹对未规律治疗的高血压患者影响较大,术前应掌握好LC适应证,注意加强术前准备及术后监护,麻醉期间加强循环、呼吸功能监护,术中严格控制气腹压力、缩短手术时间。非急诊手术患者,待血压控制满意后施术。

The impact of pneumoperitoneum on patients with different blood pressure during laparoscopic cholecystectomy

Objective ：To explore the impact of pneumoperitoneum on patients with different blood pressure during laparoscopic cholecystectomy. Methods：Eighty-seven patients undergoing laparoscopic cholecystectomy from Jan. 2010 to Jan. 2013 were divided into three groups （29 cases in each group） according to their blood pressure level. Patients in group A had a history of untreated high blood pressure and were diagnosed as high blood pressure ,while patients in group B had a history of hypertension with regular therapy and had normal blood pressure on admission. Patients in group C had no history of high blood pressure. Mean arterial pressure （MAP） ,systolic blood pressure （SBP） and diastolic blood pressure （DBP） were measured before establishing pneumoperitoneum （T1 ）, 1 min （T2 ） ,5 min （T3 ） ,10 min （T4） ,20 min （T5 ） after CO2 inflation,and 10 min after CO2 deflation （T6）. Results：MAP and SBP were not signif- icantly different in Tl and T2 among three groups （P 〉 0.05）. In T3 ,T4, T5 and T6, MAP and SBP of group A were significantly higher than those of group B and C （P 〈 0.05 ）, and there were no significant differences between group B and C （ P 〉 0.05 ）. The level of DBP was not significantly different in T1 among three groups （ P 〉 0.05 ）. In T2, T3, T4, T5 and T6, DBP of group A was significantly higher than that of group B and C （P 〈 0.05 ）, and there was no significant difference of DBP between group B and C （ P 〉 0.05 ）. Conclusions：Pneumoperitoneum significantly affects the patients with uncontrolled hypertension. The indications of laparoscopic chole- cystectomy should be selected carefully. In addition, preoperative preparation and postoperative care should be strengthened. Circular and respiratory function monitoring should be brought to the forefront during anesthesia, while the pneumoperitoneum pressure and the operation time should be strictly restricted. It is better for non-emergency patients to receive laparoscopic surge