摘要
目的观察腹腔镜下全膀胱切除术患者围术期脑钠肽(BNP)水平的变化规律,为优化围术期处理提供依据。方法选取2015年1—12月限期行腹腔镜下全膀胱切除术的患者60例,美国纽约心脏病协会(NYHA)心功能分级Ⅰ级,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,按年龄分为<65岁组和≥65岁组。记录两组患者手术、气腹和头低脚高位持续时间,术中气腹总量、补液量、尿量、出血量。在麻醉诱导前(术前)、术毕缝皮完成即刻(术毕)、术后12h和术后24h各时间点,记录患者的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、BNP水平。记录术前和术后12h的肾功能指标。结果 <65岁组患者的年龄显著小于≥65岁组(P<0.05),两组间ASA分级构成的差异有统计学意义(P<0.05),两组间性别构成、BMI、手术持续时间、气腹持续时间、头低脚高位持续时间、术中气腹总量、术中晶体液和胶体液用量、术中尿量、术中出血量、住院天数的差异均无统计学意义(P值均>0.05)。相同时间点两组间的MAP、HR和CVP的差异均无统计学意义(P值均>0.05);两组术毕、术后12和24h的MAP和CVP均显著低于同组术前(P值均<0.05);≥65岁组患者术毕的HR显著低于同组术前、术后12和24h(P值均<0.05)。两组组内各时间点间和相同时间点两组间肌酐、尿素氮和尿酸水平的差异均无统计学意义(P值均>0.05)。两组患者术毕、术后12h的BNP水平较同组术前均呈逐渐上升的趋势,两组术后12h的BNP水平均显著高于同组术前、术毕和术后24h(P值均<0.05),相同时间点两组间BNP水平的差异均无统计学意义(P值均>0.05);<65岁组和≥65岁组术后12h的BNP水平分别较术前升高(133.0±60.8)、(131.0±60.6)pg/mL,组间差异无统计学意义(P>0.05)。结论腹腔镜下全膀胱切除术中长时间气腹和头低脚高位导致患者BNP水平明显升高并持续到术后。围术期应加强患者的容量管理,合理调整心功�
Objective To observe the changes of brain natriuretic peptide （BNP） during laparoscopic resection of bladder, so as to provide the basis for optimization of perioperative management. Methods Sixty patients undergoing laparoscopic resection of bladder, the American Society of Anesthesiologists （ASA） physical status between I and II and New York Heart Association （NHYA） cardiac function class I , were recruited and divided into two groups according to their age （group A.. 〈65 years, and group B： -65 years）. Operation time, duration of pneumoperitoneum and trendetenburg, volume of pneumoperitoneum, volume of fluid input, volume of urine and bleeding during operation were recorded. Mean arterial pressure （MAP）, heart rate （HR）, central venous pressure （CVP） and BNP before anesthesia induction, at the end of operation, 12 hours and 24 hours after operation were also recorded. Blood samples were obtained preoperatively and 12 hours postoperatively for the determination of renal function. Results The age of group A was significantly lower than that of group B （P〈 0.05）, and there was significant difference in the ASA physical status between the two groups （P〈0.05）. No statistical difference was found between the two groups in gender composition, body mass index （BMI）, operation time, duration of pneumoperitoneum or trendelenburg, volume of pneumoperitoneum, volume of crystalloid or colloid fluid input, volume of urine or bleeding during operation, length of stay （all P〉0.05）. Neither were MAP,HR or CVP between the two groups （all P〉0.05）. MAP and CVP at the end of operation, 12 hours and 24 hours after operation were significantly lower than preoperative ones in each group （all P〈0.05）. In group B, HR at the end of operation was significantly lower than that before operation, at 12 hours and 24 hours after operation （all P〈0.05）. No significant difference was found in the levels of creatinine, urea nitrogen or uric acid between groups or intragroups
出处
《上海医学》
北大核心
2017年第9期556-560,共5页
Shanghai Medical Journal
关键词
围术期
脑钠肽
气腹
头低脚高位
Perioperative period
Brain natriuretic peptide
Pneumoperitoneum
Trendelenburg
