The Impact Of Different Pneumoperitoneum On Patient Underwent Laparoscopic Radical Nephrectomy

Objective:Observe different pressure of gasless laparoscopic renal patients underwent after the impact, so as to choose the appropriate gasless pressure clinical provide theoretical basis.Methods:Choose March 2009 2010 after April 40 patients underwent laparoscopic renal routine, randomly divided into low gasless pressure groups (LP group, 10mmHg) and high gasless pressure groups (HP group, 15mmHg). In continuous monitoring center before gasless enous pressure), while monitoring (CVP expiratory at the end of the carbon dioxide points pressure (PetCO₂), airway pressure (Paw), thoracic compliance (Cmpl), pulse (P), the blood oxygen saturation (SpO₂), systolic blood pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate (HR), body temperature (℃), electrocardiogram (ECG), USES the sternum on doppler heart colour exceeds the determination method of cardiac output (CO) is calculated, and cardiac index (CI), each cardiac quantity (SV), systemic resistance (SVR). Respectively on after anesthesia measured before 5 min, after 30 min, exhaust gasless after 10 min extraction arterial monitoring, arterial oxygen partial pressure (pH PaO₂), arterial carbon dioxide points pressure (PaCO₂), spo2 on (SaO₂). The whole blood alkali surplus (ABE), standard base excess (SBE). Compare two sets of gasless around different time points above respiration, circulation index and blood gas analysis of changes.Results:All 40 cases are performed success, operation time 85 120 min (average 93 and 15min). Breathing and flesh indexes to change: two groups of airway pressure (Paw) in gasless after were significantly increased (P < 0.05), HP group more evident, after both gasless recovered to measured before level. Two groups of thoracic compliance (Cmpl) in gasless after significantly (P < 0.05), HP group more remarkable, put gas recovery after to measured before level. Two groups expiratory at the end of the carbon dioxide points in PetCO₂) pressure (after gasless significantly increased (P < 0.05), and HP group more remarkable. Two groups of pH in gasless then down and were lower than 7.35, HP group more prominent, releasing air after five minLP group recovered to measured before level, and HP group still significantly below measured before level. Two groups of blood pressure (PaCO₂) carbon dioxide points in gasless increases, were higher than 45mmHg, put gas recovery and HP group after LP still significantly higher measured before level (P < 0.05). Two groups of arterial oxygen partial pressure (PaO₂) in gasless after did not change significantly (P > 0.05). Two groups SPO₂ on (SaO₂), the blood oxygen saturation (SPO₂), whole blood base excess, standard base excess in gasless after did not change significantly (P > 0.05). Circulation index changes: two groups of heart rate (HR) were significantly in gasless after increased (P < 0.05), HP group more remarkable, maintain high levels, respectively in bleed air after all recovered to measured before level. Two groups of systolic (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were significantly increased (P < 0.05), but HP group more remarkable, after releasing air 5min still did not return to a measured before level, while LP group has restored. Two groups of central enous pressure (CVP) in gasless after significantly increased (P < 0.05), HP group more prominent, releasing air after all recovered to measured before level. Two groups of systemic resistance (SVR) in gasless after significantly increased (P < 0.05), and gradually recovered to measured before level. Two groups of every heartbeat quantity (SV) in gasless changes after are not significant (P > 0.05). Two groups of cardiac output (CO) and cardiac index (CI) were measured after in significantly increased (P < 0.05), HP group more remarkable, after releasing air 5min, two group restore somewhat but still significantly higher measured before level (P < 0.05).Conclusions:The CO₂ gasless pressure to achieve 10mmHg when after laparoscopic renal vesssed can do, but due to the low pressure gasless, the operation process operative field of exposure, intraoperatie bleeding problems such as the control has the certain difficulty, cause operation time is longer, gasless prolonged, the operation is relatively difficult, But when gasless pressure to achieve 15mmHg, due to gasless pressure big, to the body, especially significant respiratory system, cause operative complication, and thus maintain gasless pressure in 10 15mmHg between, intraoperative physiological indexes, more stable operation and patients recovery is better.