高海拔地区CO₂气腹压力对机体脏器功能及血流动力学的影响

Effects of CO₂ Pneumoperitoneal Pressure on Organ Function and Hemodynamics at High Altitudes

摘要: 目的：比较高海拔地区腹腔镜不同气腹压力对患者脏器功能及血流动力学的影响。方法：选择2024年5月~2024年8月本院接收的194例腹腔镜手术患者为研究对象，经随机数表法分为观察组及对照组，各97例。两组患者均予以腹腔镜手术治疗，观察组二氧化碳气腹压力为12 mmHg，对照组二氧化碳气腹压力为8 mmHg，比较两组患者在麻醉诱导前、诱导后、手术后及术后1天的心率、血气指标(pH, $HC{O}_3^{-}$ )、肝功能指标(ALT、AST)及肾功能指标(CR、BUN)动态变化等情况。结果：两组患者在麻醉–手术周期内，心率、pH、ALT呈显著时间波动(P < 0.001)，CR接近显著波动(P = 0.106)，$HC{O}_3^{-}$ 、AST无显著时间变化；BUN组间及变化趋势有差异(P < 0.05)，其余指标组间无差异或差异无临床意义；结论：与高气腹压力相比，低气腹压力能够减少患者术中血流动力学的波动，对术中应激反应影响更小，气腹压力的选择以8~10 mmHg为宜。

Abstract: Objective: To compare the effects of different laparoscopic pneumoperitoneum pressures on organ function and hemodynamics in patients at high altitude. Methods: A total of 194 patients undergoing laparoscopic surgery in our hospital from May to August 2024 were selected as the study subjects and divided into an observation group and a control group using a random number table method, with 97 patients in each group. Both groups underwent laparoscopic surgery. The observation group received a carbon dioxide pneumoperitoneum pressure of 12 mmHg, while the control group received a pressure of 8 mmHg. The dynamic changes in heart rate, blood gas parameters (pH, $HC{O}_3^{-}$ ), liver function parameters (ALT, AST), and renal function parameters (CR, BUN) were compared between the two groups before anesthesia induction, after induction, after surgery, and one day after surgery. Results: During the anesthesia-surgery cycle, significant temporal fluctuations were observed in heart rate, pH, and ALT (P < 0.001), with a near-significant fluctuation in CR (P = 0.106). There were no significant temporal changes in $HC{O}_3^{-}$ and AST. Differences were observed in BUN between groups and in the trend of change (P < 0.05), while other parameters showed no significant differences between groups or had clinically insignificant differences. Conclusion: Compared with high pneumoperitoneum pressure, low pneumoperitoneum pressure can reduce intraoperative hemodynamic fluctuations and have a smaller impact on intraoperative stress response. The selection of pneumoperitoneum pressure should be between 8~10 mmHg.