3 research outputs found
Assessment of the influence of intra-abdominal pressure on the parameters of liver structure and function in patients undergoing laparoscopic gallbladder surgery
Trideset i Δetiri godine nakon prve laparoskopske holecistektomije (LH), koju je izveo
MΓΌhe, LH je postala zlatni standard u leΔenju kalkuloze i polipoze ΕΎuΔne kese . KljuΔni
element u laparoskopskoj hirurgiji koji pruΕΎa jasnu vidljivost i prostor za sigurnu i
efikasnu operaciju je pneumoperitoneum. Pneumoperitoneum sa visokim
intraabdominalnim pritiskom moΕΎe uticati na respiratornu, kardiovaskularnu,
hepatiΔnu i bubreΕΎnu funkciju tokom i nakon laparoskopskih operacija. MoguΔnost
promena u funkciji jetre izazvane laparoskopskom hirurgijom moΕΎe se smanjiti
skraΔivanjem vremena rada i primenom niΕΎeg intraabdominalnog pritiska (IAP). Cilj
ove studije je da proceni efekte CO2 pneumoperitoneuma na strukturne i funkcionalne
testove jetre tokom i nakon laparoskopske holecistektomije.Thirty-four years after the first laparoscopic cholecystectomy (LC), performed by MΓΌhe, LC
has become the gold standard in treating calculose and polyps of the gallbladder (1). The key
element in laparoscopic surgery that provides visual clarity and space for safe and effective
surgery is pneumoperitoneum (2). High-pressure pneumoperitoneum can effect on respiratory,
cardiovascular, hepatic, and renal function during and after laparoscopic operations (2,3). The
possibility of changes in hepatic function induced by laparoscopic surgery can be reduced by
shortening in operation time and using lower intra-abdominal pressure (IAP) (2,4). The aim of
this study is to evaluate the effects of CO2 pneumoperitoneum on structural and functional tests of the liver during and after laparoscopic cholecystectomy
ΠΡΠΊΡΠΈΠ²Π°ΡΠ΅ Ρ ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΡΠ΅ ΡΠΎΠΊΠΎΠΌ ΡΠΏΠΈΠ½Π°Π»Π½Π΅ Π°Π½Π΅ΡΡΠ΅Π·ΠΈΡΠ΅ Π·Π° ΡΠ°ΡΡΠΊΠΈ ΡΠ΅Π· ΠΊΠΎΠ½ΡΠΈΠ½ΡΠΈΡΠ°Π½ΠΈΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ Π°ΡΡΠ΅ΡΠΈΡΡΠΊΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° ΠΈ ΠΈΠ½ΡΠ΅ΡΠΌΠΈΡΠ΅Π½ΡΠ½ΠΈΠΌ ΠΎΡΡΠΈΠ»ΠΎΠΌΠ΅ΡΡΠΈΡΡΠΊΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ ΠΊΡΠ²Π½ΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° ΠΊΠΎΠ΄ Π±ΠΎΠ»Π΅ΡΠ½ΠΈΡΠ° ΡΡΠ΅ΡΠΈΡΠ°Π½ΠΈΡ Π΅ΡΠ΅Π΄ΡΠΈΠ½ΠΎΠΌ ΠΈΠ»ΠΈ ΡΠ΅Π½ΠΈΠ»Π΅ΡΡΠΈΠ½ΠΎΠΌ
Introduction/Objective. Despite frequent side effects such as hypotension, spinal anesthesia (SA) is still one of the best anesthetic methods for elective cesarean section (CS). Intermittent, oscillometric, noninvasive blood pressure monitoring (NIBP) frequently leads to missed hypotensive episodes. The objective was to compare continuous non-invasive arterial pressure (CNAP) monitoring with NIBP in the terms of efficiency to detect hypotension. Methods. In this study, we compared CNAP and NIBP monitoring for hypotension detection in 76 patients divided into two groups of 38 patients treated with ephedrine (E) or phenylephrine (P), during threeminute intervals, starting from SA, by the end of the surgery. Results. In E group, significantly lower mean systolic blood pressure (SBP) values with CNAP compared with NIBP (p = 0.008) was detected. By monitoring CNAP, we detected 31 (81.6%) hypotensive patients in E group and significantly lower number, 20 (52.6%), with NIBP (p = 0.001), while in P group CNAP detected 34 patients (89.5%) and NIBP only 18 (47.3%), p = 0.001. By monitoring CNAP, we detected significantly higher number of hypotensive intervals in E and P groups (pΠ£Π²ΠΎΠ΄/Π¦ΠΈΡ Π£ΠΏΡΠΊΠΎΡ ΡΠ΅ΡΡΠΈΠΌ Π½Π΅ΠΆΠ΅ΡΠ΅Π½ΠΈΠΌ Π΅ΡΠ΅ΠΊΡΠΈΠΌΠ° ΠΊΠ°ΠΎ ΡΡΠΎ ΡΠ΅ Ρ
ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΡΠ°, ΡΠΏΠΈΠ½Π°Π»Π½Π° Π°Π½Π΅ΡΡΠ΅Π·ΠΈΡΠ° ΡΠ΅ ΠΈ Π΄Π°ΡΠ΅ ΡΠ΅Ρ
Π½ΠΈΠΊΠ° ΠΈΠ·Π±ΠΎΡΠ° Π·Π° ΠΏΠ»Π°Π½ΠΈΡΠ°Π½ΠΈ ΡΠ°ΡΡΠΊΠΈ ΡΠ΅Π·. ΠΠ½ΡΠ΅ΡΠΌΠΈΡΠ΅Π½ΡΠ½ΠΎ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎ ΠΏΡΠ°ΡΠ΅ΡΠ΅ ΠΊΡΠ²Π½ΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° ΡΠ΅ΡΡΠΎ Π½Π΅ Π΄Π΅ΡΠ΅ΠΊΡΡΡΠ΅ Ρ
ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΠ²Π½Π΅ Π΅ΠΏΠΈΠ·ΠΎΠ΄Π΅. Π¦ΠΈΡ ΠΎΠ²Π΅ ΡΡΡΠ΄ΠΈΡΠ΅ ΡΠ΅ Π±ΠΈΠΎ Π΄Π° ΡΠ΅ ΡΠΏΠΎΡΠ΅Π΄ΠΈ ΠΊΠΎΠ½ΡΠΈΠ½ΡΠΈΡΠ°Π½ΠΎ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎ ΠΏΡΠ°ΡΠ΅ΡΠ΅ Π°ΡΡΠ΅ΡΠΈΡΡΠΊΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° ΡΠ° ΠΈΠ½ΡΠ΅ΡΠΌΠΈΡΠ΅Π½ΡΠ½ΠΈΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ ΠΊΡΠ²Π½ΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° Ρ ΡΠΌΠΈΡΠ»Ρ Π΅ΡΠΈΠΊΠ°ΡΠ½ΠΎΡΡΠΈ Ρ ΠΎΡΠΊΡΠΈΠ²Π°ΡΡ Ρ
ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΡΠ΅.ΠΠ΅ΡΠΎΠ΄Π΅ Π£ΠΏΠΎΡΠ΅ΡΠΈΠ²Π°Π½ΠΈ ΡΡ ΡΠΈΡΡΠ΅ΠΌΠΈ Π·Π° ΠΊΠΎΠ½ΡΠΈΠ½ΡΠΈΡΠ°Π½ΠΎ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎ ΠΏΡΠ°ΡΠ΅ΡΠ΅ Π°ΡΡΠ΅ΡΠΈΡΡΠΊΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° ΠΈ ΠΈΠ½ΡΠ΅ΡΠΌΠΈΡΠ΅Π½ΡΠ½ΠΎ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎ ΠΏΡΠ°ΡΠ΅ΡΠ΅ ΠΊΡΠ²Π½ΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° ΡΠ°Π΄ΠΈ Π΄Π΅ΡΠ΅ΠΊΡΠΈΡΠ΅ Ρ
ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΡΠ΅ ΠΊΠΎΠ΄ 76 Π±ΠΎΠ»Π΅ΡΠ½ΠΈΡΠ° ΠΏΠΎΠ΄Π΅ΡΠ΅Π½ΠΈΡ
Ρ Π΄Π²Π΅ Π³ΡΡΠΏΠ΅ ΠΎΠ΄ ΠΏΠΎ 38 Π±ΠΎΠ»Π΅ΡΠ½ΠΈΡΠ°, ΡΡΠ΅ΡΠΈΡΠ°Π½ΠΈΡ
Π΅ΡΠ΅Π΄ΡΠΈΠ½ΠΎΠΌ (Π) ΠΈΠ»ΠΈ ΡΠ΅Π½ΠΈΠ»Π΅ΡΡΠΈΠ½ΠΎΠΌ (Π€), Π½Π° ΡΠ²Π°ΠΊΠ° ΡΡΠΈ ΠΌΠΈΠ½ΡΡΠ°, ΠΏΠΎΡΠ΅Π²ΡΠΈ ΠΎΠ΄ ΡΠΏΠΈΠ½Π°Π»Π½Π΅ Π°Π½Π΅ΡΡΠ΅Π·ΠΈΡΠ΅ ΠΏΠ° ΡΠ²Π΅ Π΄ΠΎ ΠΊΡΠ°ΡΠ° ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡΠ΅.Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈ Π£ Π³ΡΡΠΏΠΈ Π ΡΡ Π΄Π΅ΡΠ΅ΠΊΡΠΎΠ²Π°Π½Π΅ Π·Π½Π°ΡΠ½ΠΎ Π½ΠΈΠΆΠ΅ ΡΡΠ΅Π΄ΡΠ΅ Π²ΡΠ΅Π΄Π½ΠΎΡΡΠΈ ΡΠΈΡΡΠΎΠ»Π½ΠΎΠ³ ΠΊΡΠ²Π½ΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° ΠΊΠΎΠ½ΡΠΈΠ½ΡΠΈΡΠ°Π½ΠΈΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ Π°ΡΡΠ΅ΡΠΈΡΡΠΊΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° Ρ ΠΏΠΎΡΠ΅ΡΠ΅ΡΡ ΡΠ° ΠΈΠ½ΡΠ΅ΡΠΌΠΈΡΠ΅Π½ΡΠ½ΠΈΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ ΠΊΡΠ²Π½ΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° (p = 0,008). ΠΠΎΠ½ΡΠΈΠ½ΡΠΈΡΠ°Π½ΠΈΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ Π°ΡΡΠ΅ΡΠΈΡΡΠΊΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° Π΄Π΅ΡΠ΅ΠΊΡΠΎΠ²Π°Π½Π° ΡΠ΅ 31 (81,6%) Ρ
ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΠ²Π½Π° Π±ΠΎΠ»Π΅ΡΠ½ΠΈΡΠ° Ρ Π³ΡΡΠΏΠΈ Π ΠΈ Π·Π½Π°ΡΠ½ΠΎ ΠΌΠ°ΡΠΈ Π±ΡΠΎΡ, 20 (52,6%) Π±ΠΎΠ»Π΅ΡΠ½ΠΈΡΠ°, ΠΈΠ½ΡΠ΅ΡΠΌΠΈΡΠ΅Π½ΡΠ½ΠΈΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ ΠΊΡΠ²Π½ΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° (p = 0,001), Π΄ΠΎΠΊ ΡΠ΅ Ρ Π³ΡΡΠΏΠΈ Π€ ΠΊΠΎΠ½ΡΠΈΠ½ΡΠΈΡΠ°Π½ΠΈΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ Π°ΡΡΠ΅ΡΠΈΡΡΠΊΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° Π΄Π΅ΡΠ΅ΠΊΡΠΎΠ²Π°Π½Π° Ρ
ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΡΠ° ΠΊΠΎΠ΄ 34 Π±ΠΎΠ»Π΅ΡΠ½ΠΈΡΠ΅ (89,5%), Π° ΠΈΠ½ΡΠ΅ΡΠΌΠΈΡΠ΅Π½ΡΠ½ΠΈΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ ΠΊΡΠ²Π½ΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° ΠΊΠΎΠ΄ 18 (47,3%) Π±ΠΎΠ»Π΅ΡΠ½ΠΈΡΠ°, p = 0,001. ΠΠΎΠ½ΡΠΈΠ½ΡΠΈΡΠ°Π½ΠΈΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ Π°ΡΡΠ΅ΡΠΈΡΡΠΊΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° Π΄Π΅ΡΠ΅ΠΊΡΠΎΠ²Π°Π½ ΡΠ΅ Π·Π½Π°ΡΠ½ΠΎ Π²Π΅ΡΠΈ Π±ΡΠΎΡ Ρ
ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΠ²Π½ΠΈΡ
Π΅ΠΏΠΈΠ·ΠΎΠ΄Π° Ρ Π³ΡΡΠΏΠ°ΠΌΠ° Π ΠΈ Π€ (p < 0,001). pH Π²ΡΠ΅Π΄Π½ΠΎΡΡΠΈ ΡΠΌΠ±ΠΈΠ»ΠΈΠΊΠ°Π»Π½Π΅ ΠΊΡΠ²ΠΈ Π±ΠΈΠ»Π΅ ΡΡ Π·Π½Π°ΡΠ°ΡΠ½ΠΎ Π½ΠΈΠΆΠ΅ ΠΊΠΎΠ΄ Ρ
ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΠ²Π½ΠΈΡ
Ρ ΠΎΠ΄Π½ΠΎΡΡ Π½Π° Π½ΠΎΡΠΌΠΎΡΠ΅Π½Π·ΠΈΠ²Π½Π΅ Π±ΠΎΠ»Π΅ΡΠ½ΠΈΡΠ΅ Ρ Π³ΡΡΠΏΠ°ΠΌΠ° Π ΠΈ Π€, ΠΈ ΡΠ° ΠΊΠΎΠ½ΡΠΈΠ½ΡΠΈΡΠ°Π½ΠΈΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ Π°ΡΡΠ΅ΡΠΈΡΡΠΊΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° ΠΈ ΠΈΠ½ΡΠ΅ΡΠΌΠΈΡΠ΅Π½ΡΠ½ΠΈΠΌ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΈΠΌ ΠΏΡΠ°ΡΠ΅ΡΠ΅ΠΌ ΠΊΡΠ²Π½ΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ°, ΡΠ΅ΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎ (p < 0,001, p = 0,027 Ρ Π³ΡΡΠΏΠΈ Π, ΠΈ p = 0,009, p < 0,001 Ρ Π³ΡΡΠΏΠΈ Π€).ΠΠ°ΠΊΡΡΡΠ°ΠΊ ΠΠΎΠ½ΡΠΈΠ½ΡΠΈΡΠ°Π½ΠΎ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΠΎ ΠΏΡΠ°ΡΠ΅ΡΠ΅ Π°ΡΡΠ΅ΡΠΈΡΡΠΊΠΎΠ³ ΠΏΡΠΈΡΠΈΡΠΊΠ° ΡΠ΅ ΠΌΠ½ΠΎΠ³ΠΎ Π΅ΡΠΈΠΊΠ°ΡΠ½ΠΈΡΠ΅ Ρ ΠΎΡΠΊΡΠΈΠ²Π°ΡΡ Ρ
ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΡΠ΅ ΡΠΎΠΊΠΎΠΌ ΡΠ°ΡΡΠΊΠΎΠ³ ΡΠ΅Π·Π° Ρ ΡΠΏΠΈΠ½Π°Π»Π½ΠΎΡ Π°Π½Π΅ΡΡΠ΅Π·ΠΈΡΠΈ, ΡΡΠΎ ΠΎΠΌΠΎΠ³ΡΡΠ°Π²Π° Π±ΡΠΆΠΈ ΡΡΠ΅ΡΠΌΠ°Π½ ΠΈ ΠΌΠ°ΡΠ΅ Π½Π΅ΠΆΠ΅ΡΠ΅Π½ΠΈΡ
Π΅ΡΠ΅ΠΊΠ°ΡΠ° ΠΊΠΎΠ΄ ΠΌΠ°ΡΠΊΠ΅ ΠΈ Π½ΠΎΠ²ΠΎΡΠΎΡΠ΅Π½ΡΠ΅ΡΠ°
Assessment of the influence of intra-abdominal pressure on the parameters of liver structure and function in patients undergoing laparoscopic gallbladder surgery
Trideset i Δetiri godine nakon prve laparoskopske holecistektomije (LH), koju je izveo
MΓΌhe, LH je postala zlatni standard u leΔenju kalkuloze i polipoze ΕΎuΔne kese . KljuΔni
element u laparoskopskoj hirurgiji koji pruΕΎa jasnu vidljivost i prostor za sigurnu i
efikasnu operaciju je pneumoperitoneum. Pneumoperitoneum sa visokim
intraabdominalnim pritiskom moΕΎe uticati na respiratornu, kardiovaskularnu,
hepatiΔnu i bubreΕΎnu funkciju tokom i nakon laparoskopskih operacija. MoguΔnost
promena u funkciji jetre izazvane laparoskopskom hirurgijom moΕΎe se smanjiti
skraΔivanjem vremena rada i primenom niΕΎeg intraabdominalnog pritiska (IAP). Cilj
ove studije je da proceni efekte CO2 pneumoperitoneuma na strukturne i funkcionalne
testove jetre tokom i nakon laparoskopske holecistektomije.Thirty-four years after the first laparoscopic cholecystectomy (LC), performed by MΓΌhe, LC
has become the gold standard in treating calculose and polyps of the gallbladder (1). The key
element in laparoscopic surgery that provides visual clarity and space for safe and effective
surgery is pneumoperitoneum (2). High-pressure pneumoperitoneum can effect on respiratory,
cardiovascular, hepatic, and renal function during and after laparoscopic operations (2,3). The
possibility of changes in hepatic function induced by laparoscopic surgery can be reduced by
shortening in operation time and using lower intra-abdominal pressure (IAP) (2,4). The aim of
this study is to evaluate the effects of CO2 pneumoperitoneum on structural and functional tests of the liver during and after laparoscopic cholecystectomy