CAJ | 학술논문

目的研究不同的二氧化碳(CO2)气腹持续时间对患者肾功能的影响.方法 2009年10月至2011年12月行腹腔镜手术患者89例,根据手术时间不同分成3组,即T1组(＜1 h)、T2组(1～2h)和T3组(＞2 h)；所有患者分别于术前、术后10 min、1h、24h检测血肌酐、尿肌酐和尿微量白蛋白.结果 T1组和T2组中患者术后内生肌酐清除率(Cer)较术前差异均无统计学意义(P均＞0.05),T3组中患者术后10 min Ccr较术前显著降低,差异有统计学意义(P＜0.05),术后1h和24h逐渐升高；尿微量白蛋白/尿肌酐比值(A/C)3组患者在术后均较术前显著升高,差异均有统计学意义(P均＜0.05),但术后3组之间差异无统计学意义(P ＞0.05)；T1组中≥60岁和＜60岁患者术后的肾功能比较差异均无统计学意义(P均＞0.05),T2、T3组中≥60岁患者在术后24h中Ccr均低于＜60岁患者,差异有统计学意义(P均＜0.05).结论长时间的CO2气腹可对肾功能产生显著的急性影响,在≥60岁的患者中更加明显,但在较短的时间内肾功能可逐渐恢复.
목적 연구불동적이양화탄(CO2)기복지속시간대환자신공능적영향.방법 2009년10월지2011년12월행복강경수술환자89례,근거수술시간불동분성3조,즉T1조(＜1 h)、T2조(1～2h)화T3조(＞2 h)；소유환자분별우술전、술후10 min、1h、24h검측혈기항、뇨기항화뇨미량백단백.결과 T1조화T2조중환자술후내생기항청제솔(Cer)교술전차이균무통계학의의(P균＞0.05),T3조중환자술후10 min Ccr교술전현저강저,차이유통계학의의(P＜0.05),술후1h화24h축점승고；뇨미량백단백/뇨기항비치(A/C)3조환자재술후균교술전현저승고,차이균유통계학의의(P균＜0.05),단술후3조지간차이무통계학의의(P ＞0.05)；T1조중≥60세화＜60세환자술후적신공능비교차이균무통계학의의(P균＞0.05),T2、T3조중≥60세환자재술후24h중Ccr균저우＜60세환자,차이유통계학의의(P균＜0.05).결론 장시간적CO2기복가대신공능산생현저적급성영향,재≥60세적환자중경가명현,단재교단적시간내신공능가축점회복.
Objective To investigate the effect of carbon dioxide (CO2) pneumoperitoneum with different duration periods on renal function.Methods Eighty-nine patients undergoing laparoscopic operations from October 2009 to December 2011 were divided into 3 groups according to operative time.The patients whose operative time was less than 1 hour belonged to group T1,between 1 hour and 2 hours belonged to group T2,and more than 2 hours belonged to group T3.The levels of serum creatinine,urinary creatinine,urinary microalbumin were detected at preoperation as well as 10 minutes,1 hour,24 hours after operation.Results There was no significant difference regarding of the endogenous creatinine clearance rate(Ccr) postoperatively between group T1 and T2 (P ＞ 0.05).The Ccr levels at 10 minutes after operation in group T3 was significant lower than at preoperation(P ＜0.05),and increased gradually at 1 h and 24 h after operation.The ratio of urinary microalbumin to urinary creatinine (A/C) increased at post-operation compared with at pre-operation in all 3 groups (P ＜ 0.05),but there was no significant difference between the 3 groups after operation (P ＞ 0.05).The renal function post-operation of patients over 60 years old was as same as that of patients less 60 years old in group T1 (P ＞ 0.05).However,the Ccr level in patients over 60 years old at post-operation was lower than that of patients less 60 years old in group T2 and T3 (P ＜ 0.05).Conclusion Long CO2 pneumoperitoneum could lead to the acute and obvious injury on renal function,especially in the patients over 60 years old.Fortunately,the renal function recovered to be normal gradually in a short time.