全麻下后腹腔镜手术对循环和呼吸功能的影响  

Effects of retroperitoneal laparoscopic surgery on circulatory and respiratory functions under general anesthesia

作　　者：王永光[1] 张利东[1] 徐建国[1] 高建平[2] 张征宇[2] 周水根[2] 

机构地区：[1]南京军区南京总医院麻醉科,南京210002 [2]南京军区南京总医院泌尿外科,南京210002

出　　处：《中国内镜杂志》2005年第1期15-18,共4页China Journal of Endoscopy

摘　　要：目的了解后腹腔镜手术对循环和呼吸功能的影响。方法选择择期经后腹腔镜泌尿外科手术病人16例,美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级。全麻后经Swan-Ganz导管和桡动脉监测CO气腹前后中心静脉压(CVP)、平均动脉压(MAP)、肺毛细血管楔压(PCWP)、平均肺动脉压(MPAP)、心脏指数(CI)、混合静脉血氧饱和度(SvO),同时监测气道峰压(Ppeak)、潮气末CO分压(PetCO)和动脉血气分析,并计算222二氧化碳排出量(VCO_2)、肺泡动脉血氧含量差(A-aDO)、动脉血-潮气末CO梯度(Pa-etCO)。结果2222CVP、MPAP及PCWP在气腹后各时间点均较气腹前显著增高,其几何均数的统计学检验结果均为P<0.05。气腹后CI的变化不一,无统计学意义。气腹后各时间点Ppeak均较气腹前显著增高(P<0.05)。PaCO、2PetCO于气腹后10min开始增高(P<0.05),并随手术时间的延长而继续缓慢增高,pH随PaCO的增高而22有所下降。VCO于气腹后20min开始较气腹前显著升高(P<0.05)并随着手术时间的延长而继续增高,最2高增幅达(69±6)mL/min,较气腹前增高53%。气腹后20min后各时间点Pa-etCO均较气腹前显著增高2(P<0.05),Pa-etCO的变化与手术时间、Ppeak、MPAP、PCWP均呈显著正相关(P<0.05)。结论全麻下2后腹腔镜手术对循环和呼吸功能的影响主要为:CVP、MPAP、PCWP增高,VCO。Objective: To observe the effects of retroperitoneal laparoscopic surgery on the circulatory and respiratory functions. Methods: Sixteen patients (ASA Ⅰ～Ⅱgrade) undergoing retroperitoneal laparoscopic surgery under general anesthesia were studied. The Swan-Ganz catheter and the radial artery catheter were placed to monitor the CVP, MAP, PCWP, MPAP, CI, SvO2 and draw artery blood for analysis, and the Ppeak, PetCO_2 were monitored by Julian Plus anesthesia machine and VCO2, A-aDO2, Pa-etCO_2 were calculated before and after CO2 insufflations. Results After CO_2 insufflations CVP, MPAP, PCWP increased significantly (P<0.05) and CI changed variedly. Ppeak increased significantly (P<0.05) after CO2 insufflations. PaCO_2 and PetCO_2 increased significantly 10 min after CO2 insufflations, VCO_2 increased 20 min after CO2 insufflations (P<0.05), and maintained increment during the insufflations period. The maximum increase in VCO2 was (69±6) mL/min, it was 53% higher than the VCO2 before insufflations. Pa-etCO_2 increased significantly after CO_2 insufflations (P<0.05), and it was correlated positively with operation time, Ppeak, CVP, MPAP, PCWP. Conclusion: The retroperitoneal laparoscopic surgery under general anesthesia results in the increase of CVP, MPAP, PCWP, VCO2 and Pa-etCO2.

关 键 词：后腹腔镜手术 CO2气腹 循环 呼吸 

分 类 号：R614.1[医药卫生—麻醉学]