Effect Of CO₂ Pneumperitoneum Preconditioning On Ateroal Blood Gas,Hemodynamics And Liver Function In Patients Undergoning LC

Purpose Investigate the effects of CO₂ pneumoperitoneum pretreatment on aterial blood gas,hemodynamics and liver function in patients compared with traditional pneumoperitoneum?Method 40 patients who were treated in the first people's Hospital of Chenzhou affiliated to University of South China from February,2017 to September,2017 scheduled for laparoscopic cholecystectomy were chosen as the research objects.Patients who met the criteria were randomly divided into two groups:pneumoperitoneum group?P?and pneumoperitoneum preconditioning group?PP?,with 20 cases in each group.Both groups adopted CO₂ pneumoperitoneum with intraoperative pneumoperitoneum pressure maintaining at 12 mmHg.The difference of the PP group is that pre-treatment of pneumoperitoneum inflated abdominal 5minutes,then deflated for 5 minutes.Aterial blood gases such as PH,PaO₂,PaCO₂and HCO₃^-and hemodynamic indicators such as:heart rate?HR?,systolic blood pressure?SBP?,diastolic blood pressure?DBP?,mean arterial pressure?MAP?were detected and recorded at different times before and after anesthesia induction,peritoneal CO₂ insuflation 15 minutes,peritoneal CO₂ insuflation 30 minutes and CO₂ delation 30 minutes.And detected and recorded the patients' liver function before and 24 hours after operation.pneumoperitoneumResult In the pneumoperitoneum preconditoning group?PP?and pneumoperitoneum group?P?,there were no significant difference,while Pa CO₂ shows a significant difference at the time of after pneumoperitoneum 15 minutes and peumoperitoneum 30 minutes?43.25±1.09 mmHg vs 44.90±1.18 mmHg,43.80±1.54 mmHg vs 45.53±1.62 mmHg,all P<0.05?;and HCO₃^-shows the same changes in both time?21.67±1.54mmol/L vs 20.58±1.72mmol/L,21.07±1.27 mmol/L vs 20.21±1.38mmol/L,all P<0.05?.There were no significant differences in heart rate between PP group and P group at all time points,while systolic blood pressure?SBP?,diastolic blood pressure?DBP?and mean arterial pressure?MAP?were both show significant differences on 15 minutes after pneumoperitoneum and 30 minutes after pneumoperitoneum.It's specific data show as SBP?90±21mmHg vs 103±18mmHg,92±19 mmHg vs 105±14mmHg?;DBP?60±8mmHg vs 67±11mmHg,61±7mmHg vs 69±9mmHg?;MAP?80±12mmHg vs 90±15mmHg,82±11mmHg vs 92±16mmHg?.The levels of AST and ALT,detected at 2 4 hours after operationin,in PP group and P group were respectively?57.45±22.78IU/L vs 76.24±22.65IU/L?,?52.60±15.12IU/L vs 67.45±14.60IU/L??Conclusion1.The significant differences of PaCO₂ and HCO₃^-in pneumoperitoneum preconditioning group and direct pneumoperitoneum group show that pne-umoperitoneum preconditioning can reduce intraoperative CO₂ absorption and the possibility of intraoperative acidosis.The differences in mean arterial?MAP?,systolic blood pressure?SBP?,and diastolic blood pressure?DBP?between the two groups in hemodynamics,show that pneumoperitoneum preconditioning could reduce blood pressure fluctuations caused by intraoperative pneumoperitoneum.Both reflect,pneumoperitoneum preconditioning could improve perioperative safety of patients.2.AST and ALT,detected 24 hours after surgery show significant differences between PP group and P group,suggesting that pneumoperitoneum preconditioning may have a protective effect on liver function in patients,though couldn't completely avoid functional damage.This method is simple in clinical practice,and It could reduce the damage of pneumoperitoneum on the liver function of patients,especially laparoscopic surgery requires a long time CO₂ insuflation.