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腹腔与腹膜后气腹对抗利尿激素、醛固酮和尿量的影响
The effects of antidiuretic hormone and aldosterone levels and urine output of patients in intraperitoneal pneumoperitoneum and retroperitoneal pneumoperitoneum
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DOI:
作者:
王蕾蕾 黄贞玲 周仁龙 王珊娟
Wang Leilei, Huang Zhenling, Zhou Renlong, Wang Shanjuan
作者单位:
上海交通大学医学院附属仁济医院麻醉科
Department of Anesthesiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
关键词:
腹腔气腹 腹膜后气腹 抗利尿激素 醛固酮 尿量
Intraperitoneal pneumoperitoneum; Retroperitoneal pneumoperitoneum; Antidiuretic hormone; Aldosterone; Urine output
摘要:
目的:观察腹腔和腹膜后CO2气腹时患者围术期抗利尿激素(ADH)、醛固酮(ALD)、尿量、血流动力学和CO2分压的变化,为麻醉处理提供客观依据。方法:择期行腹腔镜胆囊切除手术患者17例(Ⅰ组),后腹腔镜肾脏囊肿去顶手术患者20例(Ⅱ组),分别在麻醉前(T0)、麻醉后气腹前(T1)、气腹10min(T2)、气腹30min(T3)、放气时(T4)、放气后1h(T5)检测血浆ADH和ALD浓度,记录气腹前30min至气腹开始(U1)、气腹开始至气腹后30min(U2)、放气时至放气后30min(U3)、放气后30min至60min(U4)的尿量,记录各时间点血压、心率和CO2分压。结果:ADH和ALD组内、组间比较差异无统计学意义。Ⅰ组U2、U3尿量减少,Ⅱ组U2的尿量减少(P<0.05),Ⅰ组U3的尿量明显少于Ⅱ组(P<0.05)。与T1比较,Ⅰ组T2、T3、T4心率无显著性差异,Ⅱ组T3、T4心率下降(P<0.05),组间比较T2、T3Ⅱ组心率显著慢于Ⅰ组心率(P<0.05)。与T1比较,Ⅰ组T2血压升高,T3、T4收缩压升高,Ⅱ组T2血压升高(P<0.05),组间比较T2、T3、T4Ⅰ组血压显著高于Ⅱ组(P<0.05)。与T1比较,两组患者T2、T3、T4时PETCO2和PaCO2均明显升高(P<0.05),PETCO2组间比较无显著性差异,T3和T4Ⅱ组PaCO2显著高于Ⅰ组(P<0.05)。结论:腹腔气腹与腹膜后气腹对患者ADH和ALD无明显影响。腹腔气腹对尿量影响更大,恢复较慢,尿量减少与ADH和ALD水平无明显关系。两者对血流动力学都有一定的影响,以腹腔气腹更为显著。腹膜后气腹更易引起高碳酸血症。
Objective: To observe the effects of intraperitoneal pneumoperitoneum and retroperitoneal pneumoperitoneum on perioperative ADH、ALD、urine output、hemodynamics and CO2 partial pressure,providing an objective basis for the treatment of anesthesia. Methods: 17 patients undergoing elective laparoscopic cholecystectomy (group I) and 20 patients undergoing elective retroperitoneal laparoscopic renal cyst unroofing(groupⅡ) were studied. The plasma ADH and ALD at before anesthesia(T0),after induction of anesthesia(T1),10min after pneumoperitoneum(T2),30min after pneumoperitoneum(T3), the elimination of pneumoperitoneum(T4),1h after elimination of pneumoperitoneum(T5) were determined.Urine output were recorded from 30min before pneumoperitoneum to the establishment of pneumoperitoneum (U1),from the establishment of pneumoperitoneum to 30min after pneumoperitoneum(U2),from the elimination of pneumoperitoneum to 30min after the elimination of pneumoperitoneum(U3),from 30min to 60min after the elimination of pneumoperitoneum(U4).The hemodynamic parameters include heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at each time point. PETCO2 and PaCO2 were recorded at T1, T2, T3,T4. Results:ADH and ALD level showed no significant difference within and between groups. Compared with U1, urine output during U2 and U3 decreased significantly in group I(P<0.05),urine output during U2 decreased significantly in group Ⅱ(P<0.05), while urine output during U3 were significantly different between two groups(P<0.05). Compared with T1, HR had no significant difference at T2, T3 and T4 in group Ⅰ, but it decreased significantly at T3 and T4 in group Ⅱ (P <0.05). Between the two groups,HR decreased more significantly in group II than in groupⅠat T2 and T3 (P <0.05). In group Ⅰ, systolic blood pressure elevated at T2 and T4(P <0.05), diastolic blood pressure elevated at T2 (P<0.05). In group Ⅱ, systolic blood pressure elevated at T2(P <0.05), diastolic blood pressure elevated at T2(P <0.05). Between the two groups, systolic blood pressure were significantly higher in group Ⅰ than in group Ⅱ at T2, T3, T4 and T5(P <0.05), diastolic blood pressure were significantly higher in group Ⅰthan in group Ⅱat T2, T3, T4(P <0.05).Compared with T1,PETCO2 and PaCO2 were both increased significantly at T2、T3、T4 in two groups(P<0.05).PETCO2 showed no significant difference at all time points between two groups. PaCO2 in group Ⅱ was significantly higher than in groupⅠat T3 and T4 (P<0.05). Conclusion: Intraperitoneal pneumoperitoneum and retroperitoneal pneumoperitoneum have no significant effect on ADH and ALD. Intraperitoneal pneumoperitoneum induce urine output decrease, and recover more slowly than retroperitoneal pneumoperitoneum. They both induce hemodynamics changes, which is more significantly by intraperitoneal pneumoperitoneum. They both induce CO2 partial pressure increase, but retroperitoneal pneumoperitoneum absorbe more CO2.
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