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目的探讨小儿腹腔镜术中多种血管活性物质的变化对血压的影响。方法观察组:87名腹腔镜择期手术小儿,年龄3~14岁,均选择静脉麻醉,对照组为10名健康体检小儿,年龄2~13岁。分别检测观察组麻醉前及CO2气腹后30 m in以及对照组(清晨空腹)外周静脉血中的一氧化氮(NO)、内皮素-1(ET-I)、血管紧张素-Ⅱ(Ang-Ⅱ)、肾素(PRA)、醛固酮(ALD)浓度,同时检测血压。所有数据采用SPSS 13.0进行统计学处理。结果本组发现小儿腹腔镜CO2气腹后30 m in血压升高率达73%,同时血中NO浓度下降,ET-Ⅰ上升;术中CO2气腹30 m in后PRA、Ang-Ⅱ、ALD升高。相关分析结果显示:血压与NO量呈负相关(r=-3.58,P<0.05),与ET-Ⅰ(r=4.37,P<0.01)、PRA(r=3.27,P<0.05)、Ang-Ⅱ(r=3.29,P<0.01)、ALD(r=2.87,P<0.05)呈正相关。结论小儿腹腔镜手术可引起血压升高,原因可能是血中PaCO2升高及气腹使血流动力学变化引起NO下降,ET-Ⅰ、PRA、Ang-Ⅱ、ALD升高所致。
Objective To investigate the effect of changes of vasoactive substances on blood pressure in pediatric laparoscopic surgery. Methods Observation group: 87 children undergoing laparoscopic elective surgery, aged 3 to 14 years old, were given intravenous anesthesia. The control group was 10 healthy children aged 2-13 years. The levels of nitric oxide (NO), endothelin-1 (ET-I) and angiotensin-Ⅱ (Ang-2) in the peripheral venous blood of the observation group before anesthesia and 30 min after CO2 pneumoperitoneum and in the control group -Ⅱ), PRA, ALD and blood pressure. All data were statistically analyzed using SPSS 13.0. Results In this study, the rate of increase of blood pressure was found to be 73% at 30 m after pneumoperitoneum in children with pneumoperitoneum, meanwhile, the concentration of NO in blood was decreased and the level of ET-I was increased. The levels of PRA, Ang-Ⅱ, ALD Rise. The results of correlation analysis showed that the blood pressure was negatively correlated with the amount of NO (r = -3.58, P <0.05), but not with the level of ET-Ⅰ (r = 4.37, P <0.01) Ⅱ (r = 3.29, P <0.01), ALD (r = 2.87, P <0.05). Conclusions Pediatric laparoscopic surgery may cause an increase in blood pressure. This may be due to an increase in blood PaCO2 and pneumoperitoneum, which results in a decrease in NO and an increase in ET-I, PRA, Ang-II and ALD.