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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1562_Библиотеки_им_академика_М_И_Перельмана.pdf
Arterial Blood Gas Changes in Patients Undergoing Inguinal, Umbilical …
241
These data demonstrate that changes in pCO
2
were greater following repair of
postoperative hernias, with a decrease of 15.67% by the 1
st
postoperative day and an increase
of 9.39% by the 8
th
postoperative day. Further, there was an increase of 7.65% between the 1
st
and 8
th
postoperative days. Following repair of inguinal hernias, pCO
2
increased 10.36% by
the 1
st
postoperative day and 8.58% by the 8
th
postoperative day; and increased 2% between
the 1
st
and 8
th
postoperative days. Repair of umbilical hernias resulted in an increase of 4.9%
by the 1
st
postoperative day and 5.24% by the 8
th
postoperative day in comparison with the
preoperative day (Figures 5, 6).
Table 5. pCO
2
values (mmHg)
Hernia type
Sex
Preoperative
1
st
postoperative
day
8
th
postoperative
day
Value
SD
Value
SD
Value
SD
Inguinal hernia
Men
39.1243
3.072
36.0405
4.464
36.5486
3.05
Women
38.2769
2.748
33.3538
3.827
34.23
2.312
Total
38.7006
2.987
34.6971
4.432
35.3893
3.033
Umbilical hernia
Men
38.22857
5.308
37.04761
5.391
37.02857
4.117
Women
40.5133
3.248
37.8
3.631
37.3533
2.824
Total
39.3709
4.313
37.4238
4.394
37.1909
3.371
Postoperative hernia
Men
39.38
4.197
31.04
2.914
34.33
3.702
Women
37.665
3.995
33.835
3.931
35.426
3.112
Total
38.5225
4.074
32.4375
3.815
34.878
3.298
Table 6. pCO
2
t-test values
Hernia type
Preoperative – 1
st
postoperative day
Preoperative – 8
th
postoperative day
1
st
- 8
th
postoperative day
Inguinal hernia
<0.0005
<0.0005
0.336976
Umbilical hernia
<0.0005
0.000508
0.721688
Postoperative hernia
<0.0005
<0.0005
<0.0005
Figure 5. pCO
2
values in patients undergoing abdominal hernia repair.
Efthimia Tsounaki
242
Figure 6. pCO
2
values in patients undergoing abdominal hernia repair (men and women).
Changes in HCO
3
The changes in HCO
3
values ranged from statistically non-significant to statistically
highly significant, with a reduction of 2.78% by the 1
st
postoperative day, a reduction of
1.11% by the 8
th
postoperative day, and an increase of 1.72% between the 1
st
and 8
th
postoperative days (Tables 7, 8).
Table 7. HCO
3
values (mEq/L)
Preoperative
1
st
postoperative
day
8
th
postoperative
day
Hernia type
Sex
Value
SD
Value
SD
Value
SD
Inguinal hernia
Men
25.7162
2.314
25.0648
2.172
25.4243
1.751
Women
26.2538
1.504
23.4461
1.492
23.6
0.978
Total
25.985
2.132
24.2554
2.127
24.5121
1.772
Umbilical
hernia
Men
26.2952
2.037
26.2095
2.528
26.2333
1.578
Women
25.0933
2.716
26.52
3.513
27.2933
2.999
Total
25.6942
2.426
26.3647
3.103
26.7633
2.533
Postoperative
hernia
Men
25.08
1.344
22.84
1.269
23.8
0.529
Women
25.53
3.135
25.285
2.736
25.94
2.652
Total
25.305
2.655
24.0625
2.604
24.87
2.397
Table 8. HCO
3
t-test values
Hernia type
Preoperative – 1
st
postoperative day
Preoperative – 8th
postoperative day
1
st
- 8
th
postoperative day
Inguinal hernia
0.000412
0.009453
0.208017
Umbilical hernia
0.498678
0.178118
0.420931
Postoperative hernia
0.013086
0.676501
0.00115
Arterial Blood Gas Changes in Patients Undergoing Inguinal, Umbilical …
243
Figure 7. HCO
3
values in patients undergoing abdominal hernia repair.
Figure 8. HCO
3
values in patients undergoing abdominal hernia repair (men and women).
Changes in HCO
3
values were statistically very significant (P<0.001) with respect to the
following measurements:
Preoperative versus the 1
st
postoperative day following repair for inguinal hernias;
and
The 1
st
versus 8
th
postoperative day following repair for postoperative hernias.
Changes in HCO
3
value were statistically more significant (P<0,01) with respect to the
following measurements:
Preoperative versus the 8
th
postoperative day following repair of inguinal hernias;
and
Preoperative versus the 1
st
postoperative day for repair of postoperative hernias.
In addition, HCO
3
significant changes were found after repair of inguinal hernias, with a
decrease of 6.62% by the 1
st
postoperative day and 5.565% by the 8
th
postoperative day in
comparison with the preoperative day. Further, there was an increase of 1.06% between the
1
st
and 8
th
postoperative days. Following repair of postoperative hernias, HCO
3
decreased
4.95% by the 1
st
postoperative day and 1.75% by the 8
th
postoperative day in comparison with
the preoperative day, and increased 3.41% between the 1
st
and 8
th
postoperative days. Repair
of umbilical hernias resulted in an increase of 2.7% by the 1
st
postoperative day and of 4.27%
Efthimia Tsounaki
244
by the 8
th
postoperative day, with and an increase of 1.495% between the 1t and 8
th
postoperative days (Figures 7, 8).
Changes in SaO
2
Changes in SaO
2
values ranged from statistically non-significant at the level of 10% to
statistically very significant at the level of 0.1%, with an increase of 0.19% by the 1
st
postoperative day, an increase of 0.82% by the 8
th
postoperative day. Further, there was an
increase of 0.63% between the 1
st
and 8
th
postoperative days (Tables 9, 10).
Table 9. SaO
2
values (%)
Hernia type
Sex
Preoperative
1
st
postoperative
day
8
th
postoperative
day
Value
SD
Value
SD
Value
SD
Inguinal
hernia
Men
96.1513
1.359
96.1351
1.601
96.9189
1.233
Women
96.023
1.425
96.5815
1.483
96.923
1.0377
Total
96.0871
1.363
96.3583
1.569
96.9209
1.175
Umbilical
hernia
Men
96.6933
0.675
96.8
1.74
97.46
1.0568
Women
96.3857
1.1
95.7619
2.706
96.8333
1.197
Total
96.5395
0.947
96.2809
2.38
97.1466
1.167
Postoperative
hernia
Men
96.45
0.801
97.6
0.843
97.2
1.135
Women
95.72
3.439
96.445
3.003
96.88
2.125
Total
96.085
2.841
97.0225
2.537
97.04
1.839
Table 10. SaO
2
t-test values
Hernia type
Preoperative – 1
st
postoperative day
Preoperative – 8
th
postoperative day
1
st
- 8
th
postoperative day
Inguinal hernia
0.526664
<0.0005
0.00152
Umbilical hernia
0.37052
0.002754
0.003752
Postoperative hernia
<0.0005
0.001006
0.509852
Figure 9. SaO
2
values in patients undergoing abdominal hernia repair.
Arterial Blood Gas Changes in Patients Undergoing Inguinal, Umbilical …
245
Changes in SaO
2
value were statistically very significant (P<0.001) with respect to the
following measurements:
Preoperative versus the 8
th
postoperative day, and between 1
st
and 8
th
postoperative
days following repair of inguinal and umbilical hernias; and
Preoperative versus the 1
st
postoperative day, and preoperative versus the 8
th
postoperative day following repair of postoperative hernias.
Specifically, in this study very significant changes were noted for SaO
2
following repair
of postoperative hernias, with an increase of 0.98% by the 1
st
postoperative day and of 1.0%
by the 8
th
postoperative day. Following repair of umbilical hernias, SaO
2
decreased by 0.27%
by the 1
st
postoperative day and increased 0.64% by the 8
th
postoperative day in comparison
with the preoperative day, with an increase of 0.9% between the 1
st
and 8
th
postoperative
days. Following repair of inguinal hernias was associated with an increase of 0.86% by the 8
th
postoperative day in comparison with the preoperative day and an increase of 0.58% between
the 1
st
and 8
th
postoperative days (Figures 9, 10).
Changes in Base Excess
With respect to BE, changes ranged from statistically non-significant to statistically
highly significant, with a reduction of 1.16% during the 1
st
postoperative day, an increase of
30.2% by the the 8
th
postoperative day, and an increase of 31.73% between the 1
st
and 8
th
postoperative days (Tables 11, 12).
Changes in BE values were statistically significant (P<0.05) for the following:
Preoperative samples versus the 1
st
postoperative day, and preoperative samples
versus the 8
th
postoperative day following repair of postoperative hernias; and
The 1
st
versus the 8
th
postoperative day following repair of inguinal hernias.
Figure 10. SaO
2
values in patients undergoing abdominal hernia repair (men and women).
Efthimia Tsounaki
246
Table 11. BE values (mEq/L)
Preoperative
1
st
postoperative
day
8
th
postoperative
day
Hernia type
Sex
Value
SD
Value
SD
Value
SD
Inguinal hernia
Men
1.2
2.583
1.1675
2.188
1.7756
1.982
Women
1.5
2.113
0.9
2.115
0.97
2.513
Total
1.35
2.452
1.0337
2.151
1.3728
2.136
Umbilical
hernia
Men
1.7133
1.833
1.7385
1.42
2.231
1.094
Women
2.038
2.527
1.705
2.799
2.38
2.848
Total
1.8756
2.24
1.7217
2.342
2.3055
2.314
Postoperative
hernia
Men
0.7
1.091
1.45
1.268
1.85
1.401
Women
0.915
2.995
1.3736
2.794
1.4158
2.484
Total
0.8075
2.501
1.4118
2.353
1.6329
2.155
Table 12. BE t-test values
Hernia type
Preoperative – 1
st
postoperative day
Preoperative – 8
th
postoperative day
1
st
- 8
th
postoperative day
Inguinal hernia
0.490654
0.385213
0.040701
Umbilical hernia
0.391072
0.236218
0.160339
Postoperative hernia
0.045049
0.056961
0.392295
BE changes were particularly marked following repair of postoperative hernias, with an
increase in BE of 78.84% by the 1
st
postoperative day and of 109.61% by the 8
th
postoperative day in comparison with the preoperative day; and an increase of 15.25%
between the 1
st
and 8
th
postoperative days. In the case of umbilical hernias, BE decreased
7.54% by the 1
st
postoperative day, but increased 23.82% by the 8
th
postoperative day in
comparison with the preoperative day; and increased 34.45% between the 1
st
and 8
th
postoperative days. Repair of inguinal hernias resulted in a BE decrease of 3.33% by the 1
st
postoperative day and an increase of 1.09% by the 8
th
postoperative day in comparison with
the preoperative day; and an increase of 30.18% between the 1
st
and 8
th
postoperative days
(Figures 11, 12).
Figure 11. BE values in patients undergoing abdominal hernia repair.
Arterial Blood Gas Changes in Patients Undergoing Inguinal, Umbilical …
247
Figure 12. BE values in patients undergoing abdominal hernia (men and women).
CONCLUSION
Abdominal wall hernia repair surgery is one of the most common procedures performed
worldwide. Apart from the aesthetic effect that the hernia repair surgery has on human body,
it also leads to an increase of the intra-abdominal pressure in the immediate postoperative
period, which tends to get normalized in the later postoperative period [Gilbert, 1989; Nyhus
and Condon, 1989; Skandalakis et al., 1989; Nyhus et al., 1991; Abrahamson, 1998]. As
discussed in this chapter, the resulting intra-abdominal pressure difference has consequent
effects on the respiratory mechanics and leads to arterial blood gas changes. All the patients
evaluated for the data presented here were operated for abdominal wall hernia of medium or
large size (containing omentum and part of intestine); were normothermic; experienced
minimal blood loss during the operation and did not received blood transfusion operatively or
postoperatively; underwent similar anesthetic regimens; did not experience significant post-
operative pain; and all had the measurements performed using the same standardized
procedures. Therefore, the changes in arterial blood gases observed are presumably due to the
intra-abdominal pressure difference and its effect on respiratory mechanics. It should be noted
that all studies performed in this study were done using laparoscopicic techniques and not
open hernia repair surgery, therefore no conclusions can be drawn for changes that might
occur during open hernia repair surgery. Research has shown that by the 1
st
postoperative day
pH value increased (0.36%), pO
2
increased (1.18%), pCO
2
decreased (8.96%), HCO
3
decreased (2.78%), SaO
2
increased (0.19%), and BE decreased (1.16%). By the 8
th
postoperative day, pH increased (0.35%), pO
2
increased (4.31%), pCO
2
increased (7.01%),
HCO
3
decreased (1.11%), SaO
2
increased (0.82%), and BE increased (30.2%). The changes
observed between the 1
st
and 8
th
postoperative days were: pH had no noticeable change; pO
2
increased (3.1%); pCO
2
increased (2.14%); HCO
3
increased (1.72%); SaO
2
increased
(0.63%); and BE increased (31.73%). Clearly, changes in intra-abdominal pressure following
hernia repair surgery are associated with marked changes in arterial blood gas parameters.
Efthimia Tsounaki
248
In conclusion, arterial blood gas parameters change in patients undergoing inguinal,
umbilical and postoperative hernia repair surgery, and are greater in postoperative hernias,
than in inguinal and umbilical hernias. Further, these changes are greater in men than in
women; and they are more pronounced at the 1
st
postoperative day, and tend to moderate
toward preoperative values by the 8
th
postoperative day.
DISCLOSURE STATEMENT
The authors declare that they have no conflict of interest.
REFERENCES
Abrahamson, J. (1998). Etiology and pathophysiology of primary and recurrent groin hernia
formation. Surg. Clin. North Am, 78, 953-972.
American Society of Anesthesiologists. (2010). ASA physical status. classification system.
2010 http://www.asahq.org/clinical/physicalstatus.htm.
Bartlett, R. H. (1980). Pulmonary pathophysiology in surgical patients. Surg. Clin. North Am,
60, l323-l338.
Gilbert, A. L. (1989). An anatomic and functional classification for the diagnosis and
treatment of inguinal hernia. Am. J. Surg, 157, 331-333.
Nyhus, L. M. & Condon, R. E. (eds). (1989). “Hernia,” 3
rd
edition. J. B. Lippincott,
Philadelphia.
Nyhus, L. M., Klein, M. S. & Rogers, F. B. (1991). Inguinal hernia. Curr. Probl. Surg., 28,
403-450.
Skandalakis, J. E., Gray, S. W., Mansberger, A. R., Jr., Colborn, G. L. & Skandalakis, L. J.
(1989). “Hernia: Surgical Anatomy and Technique.” McGraw-Hill, New York.
Weibel, E. R. (1983). How does lung function affects gas exchange? Chest, 83, 657-665.
INDEX
A
access, 72, 78, 89, 128, 131, 133, 140, 141, 150,
174, 211, 213, 218, 222, 229
accounting, 155, 184
acetabulum, 221
acid, 188, 191
acidosis, 185, 189
acute renal failure, 175
adhesion, 99, 143, 198, 213, 224, 229
adhesions, 68, 72, 119, 120, 121, 128, 131, 168,
193, 213, 215, 218, 219, 222, 230
adhesives, 117
adolescents, 25, 29
adrenal insufficiency, 186
adrenaline, 105
adulthood, 5, 33, 80, 81, 193, 205
adults, 1, 2, 4, 5, 22, 41, 144, 175, 181, 187, 193,
202, 206
advancement(s), 125, 126, 129, 132, 155, 165, 167,
214
adverse event, 113
aesthetic(s), 125, 166, 167, 176, 235, 247
age, 2, 3, 5, 16, 25, 26, 27, 29, 31, 33, 34, 37, 38,
41, 58, 61, 62, 64, 65, 69, 79, 83, 88, 90, 114,
117, 122, 157, 168, 184, 187, 191, 228, 229, 237
agriculture, 12
AIDS, 17
alcohol abuse, 237
alcohol consumption, 6
algorithm, 137
alkalosis, 189
allergic reaction, 29
amniotic fluid, 193
analgesic, 229
anatomy, 1, 3, 26, 37, 38, 41, 46, 47, 52, 79, 95, 97,
125, 126, 137, 152, 155, 156, 163, 178, 179, 209,
215, 222, 223
anchoring, 69
androgen(s), 2, 4, 12, 15, 22, 43
anesthesiologist, 98
anesthetics, 98
aneurysm, 9, 16, 96
angiogenesis, 134, 231
angiography, 125, 135
angulation, 82
antibiotic, 68, 115, 117, 118
anti-inflammatory drugs, 120
anti-inflammatory medications, 214
anxiety, 99, 214
aorta, 13, 182
aortic stenosis, 13
apex, 46, 47, 181
apnea, 25, 29, 34, 35
apoptosis, 15
arrhythmias, 237
arterial blood gas, vii, 235, 236, 237, 247, 248
arteries, 13, 97, 127, 173, 181, 182
arterioles, 185
artery, 39, 40, 47, 96, 98, 99, 114, 127, 181, 185,
236
ascites, 6, 9, 70, 128
aseptic, 26, 118, 229
aspirate, 80
aspiration, 114, 148, 170, 194
assessment, 62, 122, 197, 198, 202
asymmetry, 27, 44
asymptomatic, 27, 33, 46, 49, 55, 60, 118, 158, 179,
186, 187, 193, 196
atelectasis, 190, 196
atonic, 174
atria, 188
atrophy, 29, 32, 61, 78, 81, 88, 107, 113, 119, 120,
124
attachment, 43, 49, 51, 53, 180, 231
autoantibodies, 81
autopsy, 205
Index
250
autosomal dominant, 1, 10, 11, 12, 13, 14, 18, 21,
22
autosomal recessive, 13, 14
avoidance, 26, 83, 135, 189
awareness, 139
B
back pain, 166
bacteria, 118
barium, 197
barotrauma, 189, 190, 200
barriers, 46, 213
base, 31, 56, 60, 61, 115, 157, 176, 188, 235
bedding, 229
benefits, 82, 90, 101, 134, 166, 167, 176, 233
benign, 114
benign prostatic hypertrophy, 114
benzodiazepine, 105
beta blocker, 210
bilateral, 64, 93, 195
biomaterials, 68, 72, 122, 175, 227
biopsy, 49, 148
bipedal, 3
birth weight, 35, 93
births, 5, 13, 14, 184
bladder, 51, 121
bleeding, 70, 80, 87, 114, 191, 192, 213, 217, 219,
220, 223
blood, 3, 7, 8, 14, 15, 20, 46, 80, 81, 88, 109, 114,
119, 120, 121, 127, 129, 134, 142, 175, 181, 188,
189, 229, 230, 232, 235, 236, 247
blood flow, 120, 121, 134, 175
blood pressure, 188, 189
blood supply, 88, 119, 121, 127, 129, 142
blood transfusion, 235, 247
blood vessels, 3, 14, 20, 109, 129, 230
Bochdalek hernia, 180, 187, 193, 201, 205
body fat, 8
body mass index (BMI), 6, 9, 69, 128, 168
body weight, 88
bone, 20, 97, 212, 215, 216, 217, 220, 221, 223,
224, 229
bones, 14
bowel, 27, 45, 46, 68, 69, 70, 71, 72, 73, 89, 109,
128, 141, 142, 143, 144, 145, 147, 149, 150, 152,
153, 158, 160, 163, 165, 166, 167, 168, 170, 171,
172, 174, 176, 185, 186, 187, 189, 194, 195, 196,
213, 214, 217, 220, 223, 230
bowel obstruction, 70, 141, 142, 144, 152, 153, 160,
165, 171, 194
bowel perforation, 70
bradycardia, 25, 29, 34
branching, 116, 185
breakdown, 130, 134, 174, 215
breathing, 181, 183
bronchopulmonary dysplasia, 194
brothers, 10
bypass graft, 220
C
cadaver, 129, 223
cadmium, 184
calcitonin, 1, 4, 22, 78
carbon, 229
carbon dioxide, 229
cardiac output, 220
cardiac surgery, 217
cardiovascular disease, 235
cardiovascular function, 237
cartilage, 14, 20, 127, 181
catheter, 121, 152, 170, 205
causality, 12
cell differentiation, 19, 231
cellulitis, 133
central nervous system, 184
cephalosporin, 68
challenges, vii, 83, 167
chemical, 228
chemicals, 8, 184
chest radiography, 186, 187
childhood, 2, 5, 19, 42, 46, 51, 55, 63, 93
children, 1, 2, 4, 5, 7, 10, 11, 16, 19, 21, 23, 25, 26,
27, 28, 29, 32, 33, 34, 35, 36, 37, 38, 41, 42, 46,
51, 52, 53, 60, 61, 62, 63, 64, 65, 77, 82, 84, 87,
88, 89, 90, 91, 92, 93, 144, 176, 184, 185, 190,
192, 194, 202
cholecystectomy, 168
chromosomal abnormalities, 186, 191
Chronic inguinal pain, 116
chronic obstructive pulmonary disease, 6, 128
cigarette smoke, 8
cigarette smoking, 9
circulation, 134, 185, 200, 201
cirrhosis, 6, 9, 135
cities, 207
classes, 8
classification, 23, 168, 199, 237, 248
cleaning, 30, 229
clinical application, 227
clinical assessment, 134
clinical diagnosis, 18
clinical presentation, vii, 142, 143, 224
clinical syndrome, 13
clinical trials, 10, 11, 92, 188, 191