| Objective To evaluate After the adoption of CO2 pneumoperitoneum during laparoscopic surgery and the CO2 gas pressure on the body absorb the liver and kidney function,blood coagulation, endocrine and hemodynamic effects, etc., objective evaluation of surgical retroperitoneal approach the superiority of this choice for the clinical technology to provide a theoretical basis; surgical patients by testing various indicators during and after the change, and further evaluation of surgical retroperitoneal approach the safety and risks, as the clinical ability to detect various abnormalities, to help patients to smooth out the Perioperative provide an objective theoretical basis.Methods The study of Hebei University Hospital in July 2009 to November 2010 the hospital after passing through the retroperitoneal approach laparoscopic surgery, all patients met the inclusion criteria, Application of a CO2 pneumoperitoneum continuous infusion of high CO2 gas to flow maintain the operating space, gas abdominal pressure maintained at 14mmHg, operation time was 60-240 minutes, mean 150 minutes, were recorded before surgery (T1), the conclusion of surgery (T2), on postoperative day 1 (T3), after surgery 2 days (T4),3 days after operation (T5), respectively, were recorded:1. urine; 2. renal function such as:serum creatinine, urea nitrogen, urine output, carbon dioxide combining power (CO2CP), etc.; 3. Liver power, such as:aspartate aminotransferase, alanine aminotransferase, total bilirubin; 4. clotting function, such as:prothrombin time, thrombin time ratio, activated partial thromboplastin no time, fiber fibrinogen, thrombin time, D-dimer, etc.; 5. hemodynamics, such as:blood pressure, heart rate; 6. endocrinology, such as renin, angiotensin, aldosterone, cortisol, etc.; 6. blood gas analysis, such as:PH value, HCO3-Results different time periods there was no significant difference in heart rate (P> 0.05), systolic and diastolic blood pressure in different time periods were not significantly different (P> 0.05), urine volume changes in different time periods T4, T5 than T1, T2, there was significant difference (P<0.05); serum creatinine and blood urea nitrogen in different time change was no significant difference (P> 0.05), nePHrectomy group and postoperative serum creatinine and blood urea nitrogen change was no significant difference (P> 0.05), carbon dioxide combining power than the T1 T2 change significantly, there was significant difference (P<0.05), gradually returning to normal after the next day, T5 compared with T1, no significant difference (P> 0.05); aspartate aminotransferase, alanine aminotransferase was no significant difference in changes (P> 0.05), total bilirubin T3, T4 was significantly higher than T1, a significant difference (P<0.05); blood coagulation such as:prothrombin time, fibrinogen, D-dimer and so on. D-dimer and prothrombin time before and after surgery there was significant difference (P<0.05), fibrinogen was no significant difference before and after surgery; blood gas analysis, such as:PH value, HCO3-, etc. T2, T3 compared with T1 changes are significantly different (P<0.05), but were within the normal reference range,2 days after gradually returning to normal; endocrine, such as renin, angiotensin, aldosterone changes in T4 was significantly higher than T1 changes differences (P<0.05), cortisol had no significant difference (P> 0.05).Conclusion 1. Lateral position under lumbar retroperitoneal position to raise CO2 pneumoperitoneum on body liver and kidney function in small, nor for the implementation of nePHrectomy in patients with greater impact, the implementation of the same kind of surgery, should be selected by the peritoneal After the way; 2. laparoscopic surgery on the blood coagulation system significantly affected, particularly the longer operative time, affecting more obvious, therefore, should do everything possible to shorten the operative time and improve proficiency in surgical procedures and postoperative treatment to be applied pressure and encourage patients with early ambulation to prevent venous thrombosis and the corresponding pulmonary embolism, cerebral embolism and complications; 3.CO2 gas absorption can lead to lower PH, HCO3-and other changes, and postoperative urine output decreased body metabolism caused by siltation may reinforce each other, further increasing acidosis in patients after surgery, so patients should be at least 3000ml fluid than normal to prevent the urine volume decreased significantly, and proper use of anti-oxidation and reduce free radical damage to the drug; 4.CO2CP a certain temperature and HCO3-in plasma pressure combined with the amount of CO2, the levels reflect the amount of CO2 in vivo, this study shows that postoperative blood CO2CP significantly higher than those before, mainly due to the regulation of CO2 by the lungs, so implementation of laparoscopic Preoperative pulmonary function tests were required to do, for patients with abnormal positive correction should be given until recovery or near normal lung function after surgery, such as severely impaired lung function, improvement can not open surgery is safer should be chosen; 5 retroperitoneal laparoscopic surgery less effect on cortisol, indicating that laparoscopic surgery on the body to stimulate and little interference did not cause significant release of stress hormones, but the surgery caused by renal artery and vein to stimulate the release of renin increase in renin - angiotensin - aldosterone axis activation may be involved in the mechanism of decreased urine output, so perioperative low dose of angiotensin-converting enzyme inhibitors against due to nerve - endocrine disorder caused by a transient activation of RAAS system may have some benefits... |
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