肥胖对后腹腔镜手术患者腹内压的影响

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Abstract Objective To analyze the influence of obesity on intra-abdominal pressure (IAP) of patients undergoing retroperitoneal laparoscopic surgery. Methods From October 2018 to July 2019, patients who underwent retroperitoneal partial nephrectomy at the First Hospital of Shanxi Medical University were divided into obese group and normal group according to their body mass index (BMI) level, with 30 cases in each group. The patients in both groups were maintained by retroperitoneal approach and total intravenous anesthesia. The IAP levels of supine position after anesthesia (T), the anterior and lateral position of the pneumoperitoneum (T0), 30 min after the pneumoperitoneum (T1), 60 min after the pneumoperitoneum (T2), 90 min after the pneumoperitoneum (T3), and the end of the pneumoperitoneum after 10 min (T4) were measured. The mean arterial pressure (MAP), airway pressure (Peak), oxygenation index (PaO2/FiO2), radial artery blood pH value and radial artery blood lactic acid value (Lac) at T, T0, T1, T2, T3, and T4 were recorded respectively. Results There were statistically significant differences of IAP levels in time, between groups and the interaction between the two groups (P ＜ 0.05). Among them, T0 time point was higher than T time point, T1-T3 time points were higher than T0 time point, T4 time point was lower than T1-T3 time points; IAP levels of obesity group was higher than that of normal group at each time point, and the differences were statistically significant (P ＜ 0.05). The difference between the two groups of MAP levels were statistically significant (P ＜ 0.05). The differences in time, inter-group and interaction of Peak, PaO2/FiO2, blood pH, blood Lac between the two groups were statistically significant (P ＜ 0.05). Among them, the Peak levels of the obesity group was higher than that of the normal group at each time point, while the T1-T3 time points of the two groups were higher than the T0 and T4 time points, and the differences were statistically significant (P ＜ 0.05); PaO2/FiO2 of obesity group at the T3 and T4 time points were lower than that of normal group, while T1-T4 time points were lower than T0, T3 and T4 time points were lower than T1 time point, T4 time point was lower than T2 time point, while T2-T4 time points of normal group were lower than T0 and T3 time points, T4 time point was lower than T1 time point, while T4 time point was lower than T2 time point, and the differences were statistically significant (P ＜ 0.05); the blood pH at T3 and T4 points in the obese group were lower than the normal group, while T2-T4 time points were lower than T0 time points, T3 and T4 time points were lower than T1 and T2 time points, while T2 and T3 time points of normal group were lower than T0 time point, T3 time point was lower than T1 time point, and the differences were statistically significant (P ＜ 0.05); the levels of blood Lac at T3 and T4 time points of obesity group were higher than those of control group, while the two groups at T2-T4 time points were higher than T0 time point, T3 and T4 time points were higher than T1 time point, while T4 time point was higher than T2 time point, and the differences were statistically significant (P ＜ 0.05). Conclusion Obese patients will further increase the IAP during retroperitoneal laparoscopic surgery, even exceeding the set pressure of the pneumoperitoneum, and are more likely to have increased airway pressure, decreased oxygenation index, and acid-base imbalance. For obese patients, IAP can not be simply equated with pneumoperitoneal pressure. Intraoperative monitoring should be strengthened, and IAP can be monitored if necessary.

Key words： Retroperitoneal laparoscopic surgery Obesity Intra-abdominal pressure Intra-abdominal hypertension

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	WANG Zhe1 LYU Jieping2

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WANG Zhe1 LYU Jieping2. Influence of obesity on intra-abdominal pressure of patients undergoing retroperitoneal laparoscopic surgery[J]. 中国医药导报, 2020, 17(25): 87-91.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2020/V17/I25/87

[1] Malbrain M，Chiumello D，Cesana BM，et al. A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients：the wake-up project. World initiative on Abdominal Hypertension Epidemiology，a Unifying Project （WAKE-Up!） [J]. Minerva Anestesiol，2014，80（3）：293-306.
[2] Kirkpatrick AW，Roberts DJ，de Waele J，等.世界腹腔间隙学会腹内高压和腹腔间隙综合征2013版专家共识与诊疗指南[J].中华外科杂志，2015，53（3）：173-175.
[3] 中国肥胖问题工作组.中国成人超重和肥胖症预防与控制指南（节录）[J].营养报，2004（1）：1-4.
[4] 刘志梅，仇成秀，钟琼，等.不同膀胱灌注量对腹腔内高压患者经膀胱腹腔内压力测定值的影响[J].中国医药科学，2017，7（5）：152-154.
[5] Lee RK. Intra-abdominal hypertension and abdominal compartment syndrome：a comprehensive overview [J]. Crit Care Nurse，2012，32（1）：19-31.
[6] 王旭东，张磊，刘伟，等.不同测量方法在经膀胱腹内压测量中的应用效果比较[J].中国临床医生杂志，2018，46（6）：695-696.
[7] Nazer R，Albarrati A，Ullah A，et al. Intra-abdominal hypertension in obese patients undergoing coronary surgery：A prospective observational study [J]. Surgery，2019，166（6）：1128-1134.
[8] 刘志梅，钟琼，仇成秀.不同体位及体质量指数等因素对经膀胱内途径间接测定腹内压影响研究[J].临床军医杂志，2017，45（4）：425-427.
[9] 李珍发，何剪太，彭健，等.腹腔镜手术术中气腹压对肝功能的影响[J].中国内镜杂志，2008，14（2）：131-134， 137.
[10] 鲍军明，林金萍，俞欣，等.腹腔镜肝切除术中不同气腹压对气栓及术后炎症反应的影响[J].中华医学杂志，2018， 98（26）：2088-2091.
[11] 曹建春，张东萍，李乃卿，等.腹腔压升高规律的研究[J].医学研究杂志，2008，37（6）：46-49.
[12] 刘海防，刘彦，庄海.两种不同工作原理的气腹机对妇科腹腔镜手术中患者腹腔压力的影响[J].中华医学杂志，2006，86（45）：3225-3226.
[13] 王涛，王箴，沈光贵，等.不同机械通气模式对危重患者腹内压的影响[J].中华急诊医学杂志，2016，25（6）：834-837.
[14] 仇成秀，刘志梅，钟琼.机械通气患者呼气末正压对膀胱压的影响[J].护士进修杂志，2015，30（13）：1167-1169.
[15] 余剑.腹内高压症对犬心脏、肾上腺、胰腺功能的影响及其机制研究[D].重庆：第三军医大学，2014.
[16] 陈煜，薛翔，王丽，等.腹腔筋膜室综合征对兔循环及呼吸功能的影响[J].南方医科大学学报，2012，32（9）：1312-1315.
[17] 李长坤，余剑波，宫丽荣.气腹性肺损伤的机制与防治策略[J].国际麻醉学与复苏杂志，2016，37（12）：1139-1143.
[18] Efstathios EA，Kairi E，Margonis GA，et al. Effect of Increased Intra-abdominal Pressure on Liver Histology and Hemodynamics：An Experimental Study [J]. In Vivo，2018， 32（1）：85-91.
[19] Richter S，Olinger A，Hildebrandt U，et al. Loss of physiologic hepatic blood flow control （“hepatic arterial buffer response”） during CO2-pneumoperitoneum in the rat [J]. Anesth Analg，2001，93（4）：872-877.
[20] Kopitkó C，Medve L，Gondos T. The value of combined hemodynamic，respiratory and intra-abdominal pressure monitoring in predicting acute kidney injury after major intraabdominal surgeries [J]. Ren Fail，2019，41（1）：150-158.