The Effects Of Laparoscopic Operation On Perioperative Respiratory Function

Objective The stability of the respiratory and circulatory system is vital to therecovery of patients after operation. The investigation want to dicuss the effect of variable CO2 pneumoperitoneum pressure on respiratory and circulation in laparoscopic operrations by measuring respiratory and circulation system’s parameters on the condition of 1.6kPa (12mmHg) and 2.0kPa (15mmHg)pressure,compared to open operation, we could provide a theoretical basis for clinical safety of laparoscope operation.Methods Totally 60 patients(aged 40～60 years old) undergoing pelvic malignant tumors Radical surgery, ASA I-II, were enrolled into this study. These Patients with perfect preoperative examination, no obvious abnormality of heart and lung function, according to the wishes of patients divided into control group A and pneumoperitoneum group.The pneumoperitoneum group was randomly divided into low pneumoperitoneal pressure group B(12mmHg) and high pneumoperitoneal pressure group C (15mmHg) operation.Before anesthesia (To), after tracheal intubation, before the start of operation (T1) and open (pneumoperitoneum) completed(T2), open (pneumoperitoneum) 30min (T3),60min (T4),120min (T5), pneumoperitoneum (T6) end to record the heart rate (HR), Arterial diastolic pressure (ASP), Arterial diastolic pressure (ADP), mean arterial pressure (MAP), central venous pressure (CVP) and end tidal carbon dioxide partial pressure (PetCO2), peak airway pressure (Ppeak), mean airway pressure (Pmean), plateau airway pressure (Pplat), lung compliance (Compl), alveolar dynamic compliance (Cdyn), static lung compliance(Cstat) Peak inspiratory flow (PIF), peak expiratory flow (PEF),PEEP and arterial blood gas analysis of T0-T6 extraction, according to the data calculation of intrapulmonary shunt fraction (Qs/Qt). the indexes of blood gas analysis and circular breathing changes between three groups were recorded in all time. The parameters of lung function were recorded before operation (T0), the third day after operation (T9) and the seventh day after operation (T10). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase isoenzyme 1 (LDH1), cystatinC (CysC) Of The liver and kidney function indicators were recorded at before operation (To), the operation day (T7) and the first day after operation (T8) point. arterial carbon dioxide tension (PaCO2), arterial oxygen tension (PaO2), pH (PH), blood lactate (Lac) of Arterial blood gas indexes were recorded at enter ICU point(TICU), extubation point(Textubation), the operation day (T7) and the first day after operation (T8) pointResults (1) The change of circulation:heart rate of the three groups were decreased after operation, no between group differences; ASP, ADP, MAP, CVP were increased after pneumoperitoneum at T2 point, T3 to the end of operation showed a downward trend; compared with laparotomy group, pneumoperitoneum group CVP T3-T5 point were significantly increased,T6 pneumoperitoneum group at CVP has decreased but still higher than the level before anesthesia.(2) The changes of respiration and blood gas:After pneumoperitoneum, pneumoperitoneum group PH T4-T5 point lower than the open group; operation process, significant changes in the open group did not cause PaCO2 pneumoperitoneum group at PaCO2, T3-T5 was significantly higher than that in open surgery group. Pneumoperitoneum group T3-T6 at PetCO2 was significantly higher than that of open surgery group. Pmean, Ppeak, Pplat, PEF, PIF of Pneumoperitoneum group at T2-T5 time point was significantly higher than that of laparotomy group. Thoracic compliance (compl) were significantly lower than the open group in the T2-T5 point time. (3) the change of lung function index:preoperative pulmonary function indices between the three groups have no significant difference except MMEF%. Compared with open group, FEV1%, FVC%, MMEF%,MVV%of pneumoperitoneum group were significantly higher at T9 point time. Compared with open group, MMEF%, MVV%of pneumoperitoneum group were significantly higher at T10 point time, FEV1/FVC% between the three groups had no statistical significance. Compared with open group, ALT, AST levels of 12mmHg pneumoperitoneum group were significantly higher at T7 and T8 point. There is no significant difference between B, C two groups. Compared with before operation (To), CysC level of three groups were significantly lower at T7 and T8 point. Lac level of pneumoperitoneum group were significantly higher than open group at T7 and T8 point.Conclusion Compared with open surgery group, pneumoperitoneum groups significantly influence the changes of respiratory system, but increased intra-abdominal pressure does not affect the gas exchange tissue oxygen supply and demand balance of patients during perioperative period. The recovery of pulmonary function after laparoscopic operation is quick and can help prevent the occurrence of respiratory complications.