Clinical Research Of Low Pressure CO₂ Pneumoperitoneum In Patients Undergoing Laparoscopic Gastrectomy

Objective With the extensive application of laparoscopic surgery, clinical anesthesiologists and surgeons are paying closely attention to adverse effects on the body of high pressure CO2 pneumoperitoneum. There are a lot of physiological aspects induced by mechanical compression and absorption produced CO2 pneumoperitoneum.This study intends to discuss the application value of low pressure CO2 pneumoperitoneum through investigating the effects of different pressure CO2 pneumoperitoneum in patients undergoing laparoscopic gastrectomy. It can promote the patient recovery quickly and provide new ideas of improving endoscopic operation in the perioperative management for clinical anesthesiologists and surgeons before the premise of improving the safety of operation.Methods A total of sixty patients, ASA ⅠorⅡ, scheduled for elective laparoscopic gastrectomy were randomly divided into three groups(n=20) using a random numbers table: group L, group M and group H.The pressure CO2 pneumoperitoneum were set6-8, 9-11 and 12-14 mm Hg in the three groups respectively. HR, MAP, p H, Pa CO2,Pa O2, P peak, P plat were recorded before pneumoperitoneum(T1), 1 hour after pneumoperitoneum(T2), 2 hour after pneumoperitoneum(T3) and 1 hour(T4) after stopping pneumoperitoneum. The venous blood samples at T1-T4 and 24 hour(T5) after stopping pneumoperitoneum were collected for determination of serum concentrations of NAG, Cys-C, ALT, AST, Cr,BUN and the amount of urine. The number of patients with shoulder pain was recorded 1 day after the operation in the three groups. The degree of pain were observed using visual analogue score(Visual analogue scales VAS).Then, the incidence rates of shoulder pain in the three groups were also calculated.Results Compared with T1, MAP and HR were significantly increased in the three groups at T2-T4(P<0.05). Compared with L group, MAP and HR at T2-T4 were significantly higher in the M and H group(P<0.05). Pa CO2 was obviously increased in the H and M group at T2-T4(P<0.05). Compared with T1, P peak and P plat were significantly increased in three groups at T2-T4(P<0.05), but they were not different at T1-T4 in the three groups. ALT, AST, Cr and BUN were not different at T1-T5 in the three groups. Compared with M and H group, the concentration of NAG and Cys-C at T2-T5 were significantly lower in the L group(P<0.05). Compared with L group, the amount of urine at T2-T5 was significantly lower in the M and H group(P<0.05).Compared with L group, the cases of shoulder pain were significantly increased 1 day after the operation in the H group.Conclusions Low pressure CO2 pneumoperitoneum can make hemodynamics more stable and alleviate the damage of function of liver and kidney in patients undergoing laparoscopic gastrectomy. It is able to reduce incidence of the postoperative shoulder pain, thus promoting the rapid recovery of patients.