Villa Gianluca, Fiorentino Marco, Cappellini Eleonora, Lassola Sergio, De Rosa Silvia
Department of Health Sciences, Anesthesiology Intensive Care and Pain Medicine, University of Florence, Florence, Italy.
Department of Anesthesia and Intensive Care, Oncological Anesthesia and Intensive Care, AOU Careggi, Florence, Italy.
Korean J Anesthesiol. 2024 Dec;77(6):575-586. doi: 10.4097/kja.24011. Epub 2024 Apr 26.
Pneumoperitoneum, which is established for laparoscopic surgery, has systemic implications on the renal system and may contribute to acute kidney injury or postoperative renal dysfunction. Specifically, when the pressure exceeds 10 mmHg, pneumoperitoneum decreases renal blood flow, leading to renal dysfunction and temporary oliguria. The renal effects of pneumoperitoneum stem from both the direct effects of increased intra-abdominal pressure and indirect factors such as carbon dioxide absorption, neuroendocrine influences, and tissue damage resulting from oxidative stress. While pneumoperitoneum can exacerbate renal dysfunction in patients with pre-existing kidney issues, preserving the function of the remaining kidney is crucial in certain procedures such as laparoscopic live donor nephrectomy. However, available evidence on the effects of pneumoperitoneum on renal function is limited and of moderate quality. This review focuses on exploring the pathophysiological hypotheses underlying kidney damage, mechanisms leading to oliguria and kidney damage, and fluid management strategies for surgical patients during pneumoperitoneum.
为腹腔镜手术建立的气腹对肾脏系统有全身性影响，可能导致急性肾损伤或术后肾功能障碍。具体而言，当压力超过10 mmHg时，气腹会减少肾血流量，导致肾功能障碍和暂时性少尿。气腹对肾脏的影响源于腹内压升高的直接作用以及二氧化碳吸收、神经内分泌影响和氧化应激导致的组织损伤等间接因素。虽然气腹会使已有肾脏问题的患者肾功能恶化，但在某些手术如腹腔镜活体供肾肾切除术中，保护剩余肾脏的功能至关重要。然而，关于气腹对肾功能影响的现有证据有限且质量中等。本综述重点探讨肾脏损伤背后的病理生理假说、导致少尿和肾脏损伤的机制以及气腹期间手术患者的液体管理策略。
