低二氧化碳气腹压力对2型糖尿病患者全身麻醉下卵巢囊肿切除术的影响

Effect of low CO2 pneumoperitoneum pressure on ovarian cyst resection under general anesthesia in patients with type 2 diabetes

摘要:

目的 研究低二氧化碳CO₂气腹压力对2型糖尿病（T2DM）患者全身麻醉下卵巢囊肿切除术的影响。方法 选取2020年12月—2021年12月三亚市人民医院收治的104例T2DM合并卵巢囊肿患者，根据CO₂气腹压力不同分为高压组与低压组，高压组CO₂气腹压力为14 mmHg，低压组CO₂气腹压力为11 mmHg，每组52例。两组患者均行全身麻醉下卵巢囊肿切除术。比较两组的手术指标、术后即时血糖指数、术后需用胰岛素控制病情率、血流动力学指标、卵巢功能及术后并发症。结果 两组术中出血量、手术时间比较，差异均无统计学意义（P >0.05）；低压组意识恢复时间、拔管时间均短于高压组（P <0.05）；低压组术后即时血糖指数、需用胰岛素控制病情率、呼气末二氧化碳分压（PetCO₂）均低于高压组（P <0.05）。两组不同时间点的心率（HR）、平均动脉压（MAP）比较：①不同时间点间的HR、MAP均有差异（P <0.05）；②高压组与低压组的HR、MAP有差异（P <0.05），低压组的HR、MAP较高压组低；③低压组与高压组的HR、MAP随时间变化趋势有差异（P <0.05）。低压组黄体生成素、卵泡刺激素手术前后的差值均低于高压组（P <0.05）。低压组并发症发生率9.62%低于高压组25.00%（P <0.05）。结论 T2DM患者全身麻醉下卵巢囊肿切除术中应用低CO₂气腹压力能促进术后恢复，维持血流动力学稳定，对卵巢功能影响较小，且术后并发症发生率更低。

Abstract:

Objective To investigate the effects of low CO₂ abdominal insufflation pressure on ovarian cystectomy under general anesthesia in patients with type 2 Diabetes Mellitus (T2DM).Methods A total of 104 T2DM patients with ovarian cysts treated at the Sanya People's Hospital from December 2020 to December 2021 were divided into two groups based on different CO₂ abdominal insufflation pressures: the high-pressure group (14 mmHg) and the low-pressure group (11 mmHg), with 52 patients in each group. All patients underwent ovarian cystectomy under general anesthesia. Surgical parameters, postoperative immediate blood glucose index, the need for insulin to control blood glucose postoperatively, hemodynamic parameters, ovarian function, and postoperative complications were compared between the two groups.Results There were no statistically significant differences in intraoperative blood loss and surgical duration between the two groups (P > 0.05). The low-pressure group had shorter times for regaining consciousness and extubation compared to the high-pressure group (P < 0.05). Postoperative immediate blood glucose index, the need for insulin to control blood glucose, and end-tidal carbon dioxide pressure (PetCO₂) were lower in the low-pressure group compared to the high-pressure group (P < 0.05). Comparing heart rate (HR) and mean arterial pressure (MAP) at different time points: (1) HR and MAP varied significantly at different time points (P < 0.05); (2) HR and MAP differed between the high-pressure and low-pressure groups (P < 0.05), with the low-pressure group having higher HR and MAP than the high-pressure group; (3) HR and MAP trends over time differed between the low-pressure and high-pressure groups (P < 0.05). The differences in luteinizing hormone and follicle-stimulating hormone before and after surgery were smaller in the low-pressure group compared to the high-pressure group (P < 0.05). The incidence of complications was 9.62% in the low-pressure group, lower than the 25.00% in the high-pressure group (P < 0.05).Conclusion The use of low CO₂ abdominal insufflation pressure during ovarian cystectomy under general anesthesia in T2DM patients promotes postoperative recovery, maintains hemodynamic stability, has a minimal impact on ovarian function, and results in a lower incidence of postoperative complications.