CAJ | 학술논문

目的：探讨妇科腹腔镜手术二氧化碳人工气腹对肾功能的影响。方法择期行妇科腹腔镜患者60例,美国麻醉师协会( American Society of Anesthesiologists,ASA)评分Ⅰ~Ⅱ级,体重指数<30kg/m2,随机分为4组(每组n=15)：低压短时间组(1.33kPa,持续60分钟)；低压长时间组(1.33kPa,持续120分钟)；高压短时间组(1.87kPa,持续60分钟)；高压长时间组(1.87kPa,持续120分钟)。分别观察各组术前、气腹30分钟、气腹1小时、气腹2小时、术后24小时肾功能指标：血尿素氮( blood urea nitrogen,BUN)、肌酐( cre-atinie,Scr)、血清β2-微球蛋白(β2-microglobulin,β2-MG)的变化。结果①高压长时间组中,气腹120分钟时,BUN显著升高,与组内术前相比差异有显著性(P<0.05)。②各组组内比较显示术后24小时BUN均显著降低(P<0.05)。③不同气腹压,长时间组组间比较,气腹120分钟时,高压长时间组BUN显著性升高(P<0.05)。④各组Scr、β2-MG均无显著改变(P>0.05)。结论妇科腹腔镜术中,气腹压力与作用时间可能对机体肾功能产生一定的影响,表现为气腹后尿素氮在正常范围内的一过性升高。
목적：탐토부과복강경수술이양화탄인공기복대신공능적영향。방법택기행부과복강경환자60례,미국마취사협회( American Society of Anesthesiologists,ASA)평분Ⅰ~Ⅱ급,체중지수<30kg/m2,수궤분위4조(매조n=15)：저압단시간조(1.33kPa,지속60분종)；저압장시간조(1.33kPa,지속120분종)；고압단시간조(1.87kPa,지속60분종)；고압장시간조(1.87kPa,지속120분종)。분별관찰각조술전、기복30분종、기복1소시、기복2소시、술후24소시신공능지표：혈뇨소담( blood urea nitrogen,BUN)、기항( cre-atinie,Scr)、혈청β2-미구단백(β2-microglobulin,β2-MG)적변화。결과①고압장시간조중,기복120분종시,BUN현저승고,여조내술전상비차이유현저성(P<0.05)。②각조조내비교현시술후24소시BUN균현저강저(P<0.05)。③불동기복압,장시간조조간비교,기복120분종시,고압장시간조BUN현저성승고(P<0.05)。④각조Scr、β2-MG균무현저개변(P>0.05)。결론부과복강경술중,기복압력여작용시간가능대궤체신공능산생일정적영향,표현위기복후뇨소담재정상범위내적일과성승고。
Objective To investigate the influence of carbon dioxide pneumoperitoneum on renal function in gyneco-logic laparoscopic operations. Method Sixty patients ( ASAⅠor Ⅱ, BMI<30 kg/m2 ) , scheduled undergoing per-itoneoscopic surgery were randomized into 4 groups ( n=15 fifteen patients per group ): low pressure short term group (1. 33 kPa 60 minutes), low pressure long term group (1. 33 kPa 120 minutes),high pressure short term group (1. 87 kPa 60 minutes)and high pressure long term group (1. 87 kPa 120 minutes). Comparison of preopera-tional, pneumoperitoneal 30 minutes, 1 hour, 2 hours, post operation 24 hours, the renal function indicators:blood urea nitrogen ( BUN) , creatinine ( Scr) , and serum Beta 2-microgolbulin (β2-MG) . Result In high pressure long term group (1. 87 kPa 120 minutes), compare with preoperational in the same group, BUN has gone up at 120 mi-nutes(P<0. 05). In 4 groups, the BUN has reduced clearly in the 24 hours after operation(P<0. 05). Compare with the low pressure long term group (1. 33 kPa 120 minutes), BUN has increased in the high pressure long term group (1. 87 kPa 120 minutes), when the time is on 120 minutes(P<0. 05). Another renal function indicators:Scr and serum β2-MG were unchangeable obviously(P>0. 05). Conclusion In gynaecologic laparoscopic operations, the higher pneumoperitoneal pressure(1. 87 kPa) and its longer action time(120 minutes) can produce the certain effects on the renal function, which were the transient elevation of the level of urea nitrogen in blood in the normal range.