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| 术中允许性高碳酸血症对腹腔镜肝脏切除术后肝损伤的影响 |
| Effect of intraoperative permissive hypercapnia on postoperative liver injury after laparoscopic hepatectomy |
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| DOI：10.12089/jca.2026.05.005 |
| 中文关键词: 腹腔镜肝切除术 术后肝损伤 缺血-再灌注损伤 允许性高碳酸血症 |
| 英文关键词: Laparoscopic hepatectomy Liver injury Ischemia-reperfusion injury Permissive hypercapnia |
| 基金项目:国家自然科学基金青年科学基金项目（82202297）；西安交通大学第一附属医院科研发展基金（2024-QN-35） |
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| 中文摘要: |
目的：探讨允许性高碳酸血症（PHC）对腹腔镜肝脏切除术（LH）患者术后肝损伤的影响。
方法：选择择期行LH患者，年龄18～75岁，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：PHC组和对照组。术中PHC组维持PaCO2>45～70 mmHg，对照组维持PaCO2 35～45 mmHg。主要指标为术后第1天肝功能异常发生率。次要指标包括术后第1、3天谷丙转氨酶（ALT）、谷草转氨酶（AST）、碱性磷酸酶（ALP）、总胆红素（TBIL）、白蛋白（ALB）浓度，麻醉诱导前、手术开始时、控制性降压10 min后、肝脏切除后30 min的HR、MAP、CVP，镇痛泵总按压次数、镇痛泵有效按压次数、术后拔管时间、术后住院时间。不良反应包括恶心呕吐、头晕、胸腔积液、心血管并发症、术后出血、胃排空延迟、呼吸抑制和皮肤瘙痒等。
结果：共纳入患者100例，每组50例。与对照组比较，PHC组术后第1天肝功能异常发生率明显降低，术后第1、3天ALT、AST浓度明显降低（P<0.05）。两组不同时点血流动力学指标、术后镇痛指标、术后拔管时间、住院时间、术后不良反应发生率差异均无统计学意义。
结论：LH术中实施PHC对患者术后早期肝功能具有保护作用，且对术中血流动力学、术后恢复及不良反应发生率无明显影响。 |
| 英文摘要: |
Objective: To investigate the effects of permissive hypercapnia (PHC) on postoperative liver injury in patients undergoing scheduled laparoscopic hepatectomy (LH).
Methods: Patients undergoing scheduled laparoscopic hepatectomy, aged 18-75 years, ASA physical status Ⅰ-Ⅲ, were selected. The patients were randomly divided into two groups using a random number table method: PHC group and control group. The PHC group maintained intraoperative PaCO2 at > 45-70 mmHg during the operation, while the control group maintained intraoperative PaCO2 at 35-45 mmHg. The primary outcome was the incidence of liver function abnormalities on postoperative day 1. Secondary outcomes included the concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBIL), and albumin (ALB) on postoperative days 1 and 3, HR, MAP, and CVP before anesthesia induction, at the beginning of the surgery, 10 minutes after controlled hypotension, and 30 minutes after liver resection, the total number of pressings and effective number of pressings by the analgesic pump, the time of extubation after surgery, and the postoperative hospital stay. Adverse reactions included nausea and vomiting, dizziness, pleural effusion, cardiovascular complications, postoperative bleeding, delayed gastric emptying, respiratory depression, and skin itching, etc.
Results: A total of 100 patients were enrolled in this study, 50 patients in each group. Compared with the control group, the PHC group had a significantly lower incidence of liver function abnormality on postoperative day 1, and the serum concentrations of ALT and AST on postoperative days 1 and 3 were significantly decreased (P < 0.05). There were no statistically significant differences between the two groups in intraoperative hemodynamic parameters, postoperative analgesia-related indicators, time to tracheal extubation, postoperative hospital stay, and the incidence of perioperative adverse events.
Conclusion: PHC exerted a protective effect on early postoperative liver function in patients undergoing LH, with no adverse effects on intraoperative hemodynamics, postoperative recovery, or the incidence of complications. |
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