Effects Of CO₂ Pneumoperitoneum On Perioperative Cycle Mechanics And Organ Function

Objective CO₂ pneumoperitoneum leads to some changes of cycle mechanics, organ perfusion and Internal environment In Laparoscopic surgery, thus affecting the postoperative organ function. In this study,we use the monitoring of cycle mechanics duing surgery and detection of heart, liver, kidney function after surgery to discuss the effect of cycle mechanics duing surgery and postoperative heart, liver, kidney function in CO₂ pneumoperitoneum and to provide a theoretical basis for heart, liver, kidney function perioperative maintenance in laparoscopic surgery.Methods Totally 60 patients（aged 35-60 years old） undergoing pelvic malignant tumors Radical surgery, ASA I-II, were enrolled into this study. These patients and their families were informed the experimental content and these patients have perfect preoperative examination, no abnormality of heart （CK、CK-MB、a-HBDH、cTn-I）, liver（ALB、ALT、AST、TBIL） and kidney （CERA、UERA、 Ccr） function were found. They were randomly divided into laparotomy group O, low pneumoperitoneal pressure group L（12mmHg） and high pneumoperitoneal pressure group H （15mmHg）,20 cases each group. Using the impedance cardiography to record the cardiac output （CO）、stroke volume （S V）、systemic vascular resistance （SVR）、thorax fluid content （TFC）、 acceleration Index （ACI）、velocity index （VI）、Pre-ejection period （PEP）、 left ventricular ejection time （LVET）、systolic time ratio （STR）、heart rate （HR）、systolic blood pressure （SBP）、diastolic blood pressure （DBP） at the patient into the operating room （To）、anesthesia induction and trachea cannula （Ti）、open （pneumoperitoneum） completed（T2）、open （pneumoperitoneum） 30min （T3）,60min （T4）,120min （T5）、pneumoperitoneum end （T6）. Record the CK、CK-MB、a-HBDH、cTn-I at T0、the first day after operation （T8）. Record the ALB、ALT、AST、TBIL、ALP and Ccr、CREA、 UREA at the operation day （T7）, the first day after operation （T8）,the third day after operation（T9） and the seventh day after operationa（T10）. Respectively at To, Ti, T4, T5, T6, T8, patients with central venous blood samples. Used SPSS 17.0 statistical software for data collection to data, repeated measure analysis of variance for repeated measures of comparative data, comparison between groups use ANOVA.Results （1） The changes of patients’ heart rate, blood pressure in three groups, between the two groups:heart rate at each time point in having all three groups did not differ significantly （P>0.05）, MAP in group L was significantly higher than that in open surgery group O at T2 and T5 （P<0.05）, the differences in heart rate and Mean arterial pressure between the pneumoperitoneum group L and H was not statistically significant （P>0.05）; comparison in same group:the heart rate showed a downward trend in group L and H at T2-T6 points;compared with Ti point, MAP in three group were significantly increased,had statistically significant （P<0.05）. （2） The changes of cycle mechanics, comparison between groups:TFC、PEP、LVET between three groups have no significant difference at all the points （P>0.05）, CO、SV、ACI、Ⅵ in pneumoperitoneum groups was significantly lower than that in open surgery group O at T2-T5. points,but SVR in pneumoperitoneum groups was significantly higher than that in open surgery group O at T2-T5 points （P<0.05）; In the same group:CO, H group was significantly decreased compared with T1 point T2-T5 point （P<0.05）, the group L pneumoperitoneum, laparotomy O group in T1 and T2-T5 time points no significant decline in comparison （P>0.05）,SVR in pneumoperitoneum groups increased significantly after pneumoperitoneum （P<0.05）,but there is no significant change in open surgery group O （P>0.05）. （3） Function index of the organ, comparison between groups:TBIL in pneumoperitoneum groups was significantly lower than that in open surgery group O at T7-T8 points, CK、 CK-MB in pneumoperitoneum groups was significantly higher than that in open surgery group O at T8 point （P>0.05）, SP-C in pneumoperitoneum groups was significantly higher than that in open surgery group O at T5、T6、T8 points （P<0.05）; comparison in same group:CK^ CK-MB after the operation in pneumoperitoneum groups were significantly increased compared with To point （P＜0.05）, SP-C in three groups showed an increasing trend after pneumoperitoneum （Laparotomy） （P<0.05）,open surgery group O returned to preoperative levels at T8 point, however pneumoperitoneum groups did not recover to the level before surgery at T8 point.Conclusion （1）. CO₂ pneumoperitoneum lead to the decrease of cardiac output, stroke volume, acceleration Index,velocity index and the increase of peripheral vascular resistance of the patients in the surgery.（2）. CO₂ pneumoperitoneum has little effect on perioperative liver and kidney function and myocardial enzymes. （3） CO₂ pneumoperitoneum cause serum SP-C concentrations significantly increased.