不同气腹压对老年患者腹腔镜胆囊切除术后肝功能的影响

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1、不同气腹压对老年患者腹腔镜胆囊切除术后肝功能的影响作者：傅移山刘海忠王春龚建平郭举红吴俊朱芝润廖朝兴【摘要】目的探讨不同气腹压对老年患者腹腔镜胆囊切除术(LC)后肝功能的影响及其可能机制。方法选择60岁以上老年患者行LC76例，根据术中CO2气腹压水平将患者分为3组，即低气腹压组(LP组，n＝20)腹内压(IAP)维持在1.3kPa水平、标准气腹压组(SP组，n＝33)IAP维持在1.6kPa水平和高气腹压组(HP组，n＝23)IAP维持在2.0kPa水平。其中SP组根据术中气腹维持时间再细分为两个亚组，即A亚组(时间＞50min)，B亚组(时间≤50min)。各组患者分别于术前、术后1d及术

2、后4d抽取静脉血测定血清ALT、AST含量并进行对比研究。结果SP组和HP组的血清ALT、AST水平均在术后1d明显升高(P＜0.01)，其中HP组升高较SP组明显(P＜0.01)，而LP组升高不明显(P＞0.05)。SP组在术后4d血清ALT、AST基本恢复至正常水平，而HP组虽有下降，但多数患者仍高于正常水平。SP组中的A亚组术后1d血清ALT、AST升高水平明显高于B亚组(P＜0.01)。结论腹腔镜胆囊切除术中建立的CO2气腹可能引起老年患者术后一过性肝功能异常，且与CO2气腹压的高低和维持时间有关。9【关键词】肝功能气腹压腹腔镜胆囊切除术Changesofhepaticfunction

3、inelderlypatientsundergonelaparoscopiccholecystectomyinresponsetodifferentpneumoperitoneumpressureFUYishan,LIUHaizhong,WANGChun,GONGJianping,GUOJuhong,WUJun,ZHUZhirun,LIAOChaoxin.DepartmentofSurgery,theCentralHospitalofXipeng,Chongqing401326,China【Abstract】ObjectiveTodiscusstheeffectofdifferen

4、tpneumoperitoneumpressureonchangesofhepaticfunctioninelderlypatientstreatedwithlaparoscopiccholecystectomy(LC)andthecorrespondingmechanism.MethodsAtotalof76patientsatageover60yearstreatedwithLCweredividedintothreegroups,ie,lowpneumoperitoneumpressuregroup(GroupLP,n=20),standardpneumoperitoneumpressu

5、regroup(GroupSP,n=33)andhighpneumoperitoneumpressuregroup(GroupHP,n=23)basedonintraoperativeCO2pneumoperitoneumpressure.Duringoperation,theintra-abdominalpressure(IAP)remainedat1.3kPainGroupLP,1.6kPainGroupSPand2.0kPainGroupHP.Inthemeantime,accordingtomaintenanceofintraoperativepneumoperitoneum,Grou

6、pSPwassubdividedintotwogroupsincludingGroupA(>509min)andGroupB(≤50min).Then,thevenousbloodwascollectedatday1preoperativelyandatdays1and4postoperativelyrespectivelytodetermineandcomparethecontentsofalanineaminotransferase(ALT)andaspartateaminotransferase(AST)inallgroups.ResultsAtday1postoperativel

7、y,thecontentsofALTandASTinGroupsSPandHPweresignificantlyincreased(P<0.01),withmoresignificantincreaseinGroupSP(P<0.01)butinsignificantincreaseinGroupLP（P＞0.05）.Atday4postoperatively,bloodserumAL