胆囊结石患者全麻术中胆囊压力升高的影响因素分析

摘要

目的 探讨胆囊结石患者全麻术中胆囊压力升高的影响因素.方法 选择2014年1月至2015年12月大连大学附属中山医院收治的胆囊结石患者168例,分组观察单因素(结石部位、结石数量、最大结石直径、胆囊壁厚度、胆囊收缩功能、胆囊分隔)对全麻术中胆囊压力的影响.结果 168例患者中,胆囊腔内结石146例,胆囊管结石22例,两者压力差异有统计学意义(t=8.033,P<0.001).146例胆囊腔内结石中,胆囊壁厚3 mm共94例,4 mm共40例,5 mm及以上共12例,3 mm与5 mm以上压力相比,差异有统计学意义(t=2.056,P=0.042).134例胆囊壁厚小于5 mm中,单枚结石33例,2～10枚83例,≥11枚18例,平均压力组间差异无统计学意义(P>0.05);最大结石直径≤10 mm共79例,10～20 mm共40例,≥20 mm共15例,组间差异无统计学意义(P>0.05);胆囊排空指数≤30％共19例,30％～50％共24例,≥50％共55例,平均压力组间差异无统计学意义(P>0.05);有胆囊分隔27例,无胆囊分隔107例,两者压力差异无统计学意义(P>0.05).结论 胆囊管结石及胆囊壁增厚是引起全麻术中胆囊压力升高的主要因素.%Objective To investigate the influencing factors of increased gallbladder pressure during general anesthesia in patients with gallstone. Methods The clinical data of 168 gallstone patients in Affiliated Zhong-shan Hospital of Dalian University from Jan. 2014 to Dec. 2015 were classified into six groups, to observe the changes of gallbladder pressure during general anesthesia. Results Among the 168 patients, there were 146 cases with gallstones and 22 cases with cystic duct stones and their differences of the gallbladder pressure was statistically significant (t=8.033, P<0.001). Among the 146 patients with gallstones, the thickness of gallbladder wall was 3 mm in 94 cases, 4 mm in 40 cases, and more than 5 mm in 12 cases. The difference of gallbladder pressure between 3 mm and more than 5 mm gallbladder wall thickness was statistically significant (t=2.056, P=0.042). In 134 cases with gallbladder wall thickness less than 5 mm, there was only one stone in 33 cases, 2 to 10 stones in 83 cases, and more than 11 stones in 18 cases. There were no significant differences of gallbladder pressure among these groups. The maximum stone diameter was less than 10 mm in 79 cases, 10 to 20 mm in 40 cases, more than 20 mm in 15 cases. The gallbladder pressure had no significant difference among these groups (P>0.05). The gallbladder emptying index was less than 30％ in 19 cases, 30％ to 50％ in 24 cases, more than 50％ in 55 cases and the gallbladder pressure had no significant difference among these groups (P>0.05). There was gallbladder separation in 27 cases and no gallbladder separation in 107 cases, with no significant gallbladder pressure difference between the two groups (P>0.05). Conclusion Cystic duct stone and thickening of gallblad-der wall are the main factors resulting in the increase of gallbladder pressure during general anesthesia.