Application of segmented management of CO₂ pneumoperitoneum pressure in da Vinci robotassisted partial nephrectomy
CO₂气腹压力分段管理在达芬奇机器人辅助肾部分切除术中的应用

摘要

目的 探讨CO₂气腹压力分段管理在达芬奇机器人辅助肾部分切除术中的应用效果，旨意为相关人员的研究工作提供参考资料。方法 采用方便抽样，将40例在我院需行达芬奇机器人辅助肾部分切除术的病人随机分成对照组和观察组，对照组术中使用恒定（13mmHg）CO₂气腹压力，观察组根据手术节点分段调节CO₂气腹压力：组织游离期调节压力为13mmHg；热缺血期调节压力为15 mmHg；缺血再灌注期调节压力为9 mmHg；分别记录两组三期血压、心率、热缺血时间、呼气末CO₂分压、热缺血时间、术中出血量、术后引流量、术后 24小时尿量。结果 两组热缺血时间、术中出血量比较，有明显统计学意义（P<0. 01）。术后引流量比较有统计学意义（P<0. 05）。结论 将CO₂气腹压力分段管理应用于达芬奇机器人辅助肾部分切除术中，可以有效缩短热缺血时间，减少术中出血和术后引流量，使得病人获益，值得在临床上推广。

Abstract

Objective To explore the application effect of CO₂ pneumoperitoneum pressure stage management in Da Vinci robot-assisted partial nephrectomy, and to provide reference for relevant personnel.
Methods By convenient sampling, 40 patients who needed Da Vinci robot assisted partial nephrectomy in our hospital were randomly divided into control group and observation group. The control group used constant (13mmHg) CO₂ pneumoperitoneum pressure during the operation, and the observation group adjusted CO₂ pneumoperitoneum pressure according to the operation node: the adjusted pressure during the tissue free period was 13mmHg; The regulated pressure was 15 mmHg during hot ischemia. The regulating pressure during ischemia-reperfusion period was 9 mmHg; Blood pressure, heart rate, hot ischemia time, end-expiratory CO₂ partial pressure, hot ischemia time, intraoperative blood loss, postoperative drainage volume, and urine volume 24 hours after surgery were recorded respectively.
Results The thermal ischemia time and intraoperative blood loss were significantly compared between the two groups (P< 0.01). The postoperative drainage volume was statistically significant (P< 0.05).
Conclusion   The application of CO₂ pneumoperitoneum pressure in Da Vinci robot-assisted partial nephrectomy can effectively shorten the time of hot ischemia, reduce intraoperative bleeding and postoperative drainage flow, and bring benefits to patients, which is worthy of clinical promotion.