腹腔镜胆囊切除术中气腹压和气腹持续时间对病人内脏灌注的影响  

Effects of intra-abdominal pressure and duration of pneumoperitoneum on splanchnic perfusion in patients undergoing laparoscopic cholecystectomy

作　　者：曹晓莹[1] 梁伟民[1] 谢致[1] 顾华华[1] 王倩[2] 

机构地区：[1]复旦大学附属华山医院麻醉科,上海市200040 [2]复旦大学临床流行病教研室,上海市200040

出　　处：《中华麻醉学杂志》2005年第11期807-810,共4页Chinese Journal of Anesthesiology

摘　　要：目的探讨腹腔镜胆囊切除术中气腹压及气腹持续时间对病人内脏灌注的影响。方法 50例ASA Ⅰ或Ⅱ级、年龄<65岁的择期腹腔镜下单纯胆囊切除术病人,随机分为气腹压12 mm Hg 组(LC1)和气腹压15 mm Hg组(LC2),每组25例。全麻诱导气管插管后行机械通气,1．5％-2％异氟醚吸入,间断给予芬太尼、维库溴铵维持麻醉。术中维持PETCO2约34 mm Hg。于麻醉诱导前即刻 (T1)、气管插管后30min(T2)、气腹30min(T3)、60min(T4)、放气后30min(T5)、入麻醉恢复室后1 h (T6)、2 h(T7)、3 h(T8)监测并记录循环指标、血气分析及胃粘膜二氧化碳分压(PgCO2)。根据 Henderson-Hasselbalch公式计算胃粘膜pH(pHi)和胃粘膜与动脉血二氧化碳分压梯度(PCO2gap)。结果与T1比较,两组T6-8时PgCO2升高,pHi下降(P<0．01),PCO2gap差异无统计学意义。与T2比较, LC1组T3-5时PgCO2、pHi、PCO2gap差异无统计学意义。与T2、T3及LC1组比较,LC2组T4时PgCO2、 PCO2gap升高,pHi降低(P<0．01),T5上述参数恢复至气腹前水平。结论腹腔镜胆囊切除术中腹内压15 mm Hg时,随气腹时间的延长(60 min)可引起短时的内脏低灌注。腹腔镜胆囊切除术中腹内压维持在12mmHg较为适宜。Objective The present study was designed to compare the effects of different intra-abdominal pressure and the duration of pneumoperitoneum on splanchnic perfusion during laparoscopic cholecystectomy. Methods Fifty ASA Ⅰ or Ⅱ patients aged 〈 65 yrs undergoing laparoscopic cholecystectomy were randomly divided into 2 groups （n = 25 each ） according to the intra-abdominal pressure during pneumoperitoneum： group Ⅰ 12 mm Hg （LC1） and group Ⅱ 15 mm Hg （LC2）. The patients were premedicated with oral ranitidine 150 mg and intramuscular atropine 0.5 mg. Gastric tonometry tube （F14） was placed and radial artery cannulated before induction of anesthesia. Anesthesia was induced with midazolam 1-2 mg, propofol 1.5-2.0 mg·kg^-1 , fentanyl 2 μg·kg^-1 and vecuronium 0.1 mg·kg^-1 and maintained with 1.5%-2.0% isoflurane inhalation and intermittent IV boluses of fentanyl and vecuronium after tracheal intubation. The patients were mechanically ventilated （ RR = 10 bpm, I ： E = 1 ： 2）. PETCO2, was maintained at about 34 mm Hg by adjusting tidal volume （ VT ） . MAP, HR, SpO2 and PETCO2 were continuously monitored during anesthesia. PgCO2 （ gastric mucosal CO,. tension） was measured automatically every 10 min. Arterial blood samples were obtained before induction of anesthesia （T1 , baseline）, 30 min after intubatin （T2） 30 and 60 min after CO2 insufflation （T3,4）, 30 min after deflation （T5 ） and at 1, 2, 3 h after operation in PACU （T6-8） for blood gas analysis. Gastric intramucosal pH （pHi） and gastric intramucosal-artefial PCO2 gradient （PCO2 gap） were calculated according to Henderson-Hasselbalch equation. Results PgCO2, was significantly increased and phi decreased at T6-8 as compared to the baseline values （T1） in both groups. PgCO2 was significantly higher and phi significantly lower at T4 in group LC2 than in group LC1 （P 〈 0.01）. These parameters returned to the pre-pneumoperitoneum level at 30 min after deflation （T5） . Conclusion In o

关 键 词：气腹 胆囊切除术 腹腔镜 灌注 局部 

分 类 号：R614[医药卫生—麻醉学]