腹腔镜胆囊切除术中CO_2气腹压力变化对心率(律)、血压、心电图的影响  

Effects of variations in CO_2 pneumoperitoneum pressure on HR, BP and ECG during laparoscopic cholecystectomy

作　　者：刘松[1] 郭峰[1] 蔡永良[1] 章红专 赵云焕[1] 王介川[1] 余国庆[1] 赵丽芬[1] 张媛香 

机构地区：[1]浙江省杭州市萧山区第四人民医院肝胆外科,浙江杭州311225

出　　处：《安徽医药》2006年第3期202-204,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的 观察腹腔镜胆囊切除术（LC）中，CO2气腹压力值不同。对不同年龄组患者心率（律）、血压、心电图的影响。探讨其合适的压力值及措施。方法 对68例LC病人分40岁以下、41～60岁、61岁以上三组分别监测麻醉平稳后气腹前，腹压〈8mmHg、10～12mmHg及14mmHg四个值段时病人心率、血压、心电图情况。结果 CO2气腹开始至腹压8mmHg，各指标变化率最高，腹压值在10～12mmHg时最低，且年龄越高变化越明显。尤其对60岁以上高龄或合并心、肺等疾病的患者，更应高度重视。结论 LC术中实施CO2气腹，对病人循环功能会产生一定程度影响，并与初始阶段进气速度和腹压值及年龄呈正相关性。加强术中监测，选择合适的初始进气速度和腹压值是十分必要的。Aim To investigate the effects of variations in CO2 on heart rate （HR）, blood pressure （BP）, and electrocardiogram （ECG） during laparoscopic cholecystectomy（ LC）, so as to observe the proper capnoperitoneum pressure. Methods 68 patients undergoing LC were divided into three groups ：below 40 ,41 ～ 60, and over 61 years old. Anesthesia was standardized, and the carbon dioxide pneumoperitoneum pressure rose from 8 mmHg to over 14mmHg： 〈 8 mmHg, 10 ～ 12 mmHg and 14 mmHg. then we respectively observed the changes of HR, BP and ECG. Results Insufflation produced a peak in all the indexs while the pressure reached 8 mmHg,the other way round,the changing rate was the smallest when the pressure ranged between 10 ～ 12 mmHg,especially for those patients over 60, or anyone who has cardiopulmonary diseases. Conclusions Peritoneal insufflation exerts detectable effects on hemodynamics during laparoscopic cholestectomy （LC）, which positively contrasts with the speed of insufflation,capnoperitoneum and ages. In that case it is quite necessary to enhance observation, as well as to select the proper speed of insufflation and intraabdominal pressure during LC.

关 键 词：腹腔镜胆囊切除术 CO2气腹 心率 血压 心电图 

分 类 号：R657.4[医药卫生—外科学] R654.2[医药卫生—临床医学]