Effects of different pneumoperitoneum pressure on liver,kidney and respiratory function during laparoscopic cholecystectomy
10.3760/cma.j.issn.1008-6706.2018.07.026
- VernacularTitle:腹腔镜胆囊切除术中不同气腹压力对患者肝肾功能及呼吸功能的影响
- Author:
Hua CHEN
1
Author Information
1. 313100,浙江省长兴县中医院普外科
- Keywords:
Pneumoperitoneum;
Laparoscope;
Respiratory function
- From:
Chinese Journal of Primary Medicine and Pharmacy
2018;25(7):915-919
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effects of different pneumoperitoneum pressure on liver,kidney and respiratory function during laparoscopic cholecystectomy.Methods 240 patients who received laparoscopic cholecystectomy,were selected.They were divided into low pressure group (n =120) and high pressure group (n =120).The indicators of liver and respiratory function (ALT,AST,TBIL,IBIL,DBIL,A,G,TP,LDH,ALP,GGT,BUN,Scr,β2-MG,IC,FVC,FEV1,PEF,VC,MVV,FEF25 ％ ～ 75％) were monitored on the 1 st day before operation and on the 1 st,3rd day after operation.The indicators of kidney function were monitored at preoperative 10min,intraoperative 1 h and postoperative 1 day.Results Liver function index:on the preoperative 1 day,the ALT,AST,TBIL were in the reference range,there were no statistically significant differences between the high pressure group and low pressure group(all P ＞ 0.05).On the 1st day after operation,the AST,TBIL,ALT and LDH index in the two groups were increased(t =4.132,P=0.023;t =4.231,P =0.021;t =3.615,P =0.043;t =4.561,P =0.331) (t =4.645,P =0.014;t =4.793,P =0.012;t =4.135,P =0.025;t =4.561,P =0.037),and the ALT,AST,TBIL,IBIL,A,LDH,GGT in the high pressure group were higher than those in the low pressure group (t =3.429,P =0.045;t =3.656,P =0.041;t =3.144,P =0.043;t =4.014,P =0.041;t =2.947,P =0.032;t =3.415,P =0.039;t =2.893,P =0.029).On the 3 rd day after operation,the TBIL,DBIL,LDH,GGT index in the two groups were closed to the normal value (t=l.342,P=0.037;t=l.275,P=0.039;t =l.893,P=0.028;t=l.413,P=0.032;t =1.348,P=0.035;t =1.289,P =0.037;t =1.899,P =0.026;t =1.453,P =0.024),and the ALT,AST,IBIL,LDH of the high pressure group were significantly higher than those of the low pressure group (t =4.132,P =0.036;t =4.653,P =0.029;t =3.567,P =0.038;t =4.112,P =0.031).Respiratory function index:at preoperative 1 day,the respiratory function indicators of the two groups were within the reference range,the differences between the two groups were not statistically significant(all P ＞ 0.05).On the 1 st and 3rd after operation,those indicators had statistically significant differences between the two groups(t =1.786,P =0.017;t =1.823,P =0.014;t =1.463,P =0.012;t =1.855,P =0.011;t =1.931,P =0.018;t =1.991,P =0.013;t =2.314,P =0.019;t =1.427,P =0.021;t =1.721,P =0.019;t =1.854,P =0.018;t =1.775,P =0.023;t =1.764,P =0.022;t =1.938,P =0.019;t =1.897,P =0.020).Renal function index:at preoperative 10 min,intraoperative 1 h,and the 1 st day after operation,the BUN,Scr and β2-MG levels had no statistically significant differences between the two groups (all P ＞ 0.05).The level of BUN had no obvious change in the perioperative period (P ＞ 0.05).The Scr,β2-MG in the two groups were significantly increased at intraoperative 1 h and the 1 st day after operation compared with preoperative 10min (t =1.912,P =0.017,t =1.867,P =0.021;t =1.862,P =0.020,t =1.752,P =0.032;t =1.378,P =0.029,t =1.419,P =0.026;t =1.568,P =0.023,t =1.927,P =0.019).Conclusion CO2 pneumoperitoneum has transient damage to the patients' liver function,and lower pneumoperitoneum pressure is useful to the protection of liver function;CO2 pneumoperitoneum can lead to reversible kidney damage and reducing the pneumoperitoneum pressure has little effect on renal function;higher CO2 pneumoperitoneum pressure should influence respiratory function,therefore respiratory function should be closely monitored.
