不同气腹压对老年患者腹腔镜胆囊切除术后肝功能影响.docVIP

不同气腹压对老年患者腹腔镜胆囊切除术后肝功能影响 　 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LC 76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1.3 kPa水平、标准气腹压组(SP组，n＝33)IAP维持在1.6 kPa水平和高气腹压组(HP组，n＝23)IAP维持在2.0 kPa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＞50 min)，B亚组(时间≤50 min)。各组患者分别于术前、术后1 d及术后4 d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1 d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4 d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。 【关键词】 肝功能 气腹压 腹腔镜胆囊切除术 Changes of hepatic function in elderly patients undergone laparoscopic cholecystectomy in response to different pneumoperitoneum pressure FU Yishan, LIU Haizhong, WANG Chun, GONG Jianping, GUO Juhong, WU Jun, ZHU Zhirun, LIAO Chaoxin. Department of Surgery, the Central Hospital of Xipeng, Chongqing 401326, China 【Abstract】 Objective To discuss the effect of different pneumoperitoneum pressure on changes of hepatic function in elderly patients treated with laparoscopic cholecystectomy (LC) and the corresponding mechanism. Methods A total of 76 patients at age over 60 years treated with LC were divided into three groups, ie, low pneumoperitoneum pressure group (Group LP, n=20), standard pneumoperitoneum pressure group (Group SP, n=33) and high pneumoperitoneum pressure group (Group HP, n=23) based on intraoperative CO2 pneumoperitoneum pressure. During operation, the intra-abdominal pressure (IAP) remained at 1.3 kPa in Group LP, 1.6 kPa in Group SP and 2.0 kPa in Group HP. In the meantime, according to maintenance of intraoperative pneumoperitoneum, Group SP was subdivided into two groups including Group A (gt;50 min) and Group B (≤50 min). Then, the venous blood was collected at day 1 preoperatively and at days 1 and 4 postoperatively respectively to determine and compare the contents of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in all g