硬膜外麻醉下妇科腹腔镜手术血浆肾素—血管紧张素系统和β微球蛋白含量的变化

目的观察硬膜外麻醉下，妇科腹腔镜手术患者在低CO2气腹压和15.头低脚高体位时肾素-血管紧张素系统(RAAS)和肾小球滤过率(GFR)的变化。方法监测20例患者气腹前、腹内压达1.33～1.59kPa后10、30、60分钟及解除气腹后10分钟五个时点血浆肾素(PRA)、血管紧张素Ⅱ(AⅡ)、醛固酮(ALD))和β

Changes of reni-angiotensin system and

Objective To investigate the changes of renin-angiotensin-aldosterone system (RAAS) and glomerular filtration rate (GFR) in epidurally-anesthetized patients undergoing gynecological laparoscopy with 15° head-down position and low insufflation pressure. Methods Twenty gynecological patients(ASA grade I- Ⅱ )were studied during CO2 insufflation with an intra-abdominal pressure of 1012mmHg and 15° head-down position. Arterial blood samples were obtained for the measurements of serum concentrations of plasma renin activity(PRA), angiotensin Ⅱ (All), aldosterone(ALD) and β2-microglobulin(β2-MG)by radioimmunoassay at the following five time points: before insufflation, at 10min, 30min and 60 min after insufflation respectively and after desufflation. Arterial blood gas analysis was made in 10 of the cases simultaneously. Results Compared with preinsufflation, there was no significant decrease in the plasma levels of PRA, All ,ALD and β2-MG during CO2 pneumoperitoneum except for PRA at 10 min after insufflation(P ＜0.05). As the time of insufflation went on, the measurements above showed a tendency of slightly increase. The PaCO2 during peritoneal CO2 insufflation was increeseing ( P ＞ 0.05) and reached its maximum at 30 min after insufflation. The pH values of 30～60 min after insufflation were significantly decreased as compared with that of before insufflation. Conclusion The epidural anesthesia may inhibit the response of RAAS to (CO2 insufflation pressure of 10-12mmHg and has no effect on GFR during gynecological laParoscopy.