全麻下腹腔镜胆囊切除术二氧化碳气腹对呼吸循环影响的临床研究  

The effects of CO 2 pneumoperitoneum on respiration and circulation in laparoscopic cholecystectomy during general anesthesia

作　　者：丁玉兴[1] 许太武[1] 

机构地区：[1]成都军区昆明总医肝胆外科

出　　处：《中国普通外科杂志》1997年第1期22-24,共3页China Journal of General Surgery

摘　　要：择期腹腔镜胆囊切除术（ＬＣ）手术患者１００例，全部采用气管内插管全麻，分别于气腹前、气腹后５、１０、２０分钟测定心率（ＨＲ）、收缩期血压（ＳＢＰ）、脉博氧饱和度（ＳｐＯ２）、呼吸道压力（Ｐａｗ）、呼气终末ＣＯ２分压（ＰｅｔＣＯ２）。结果表明，气腹５、１０分钟后，ＨＲ、ＳＢＰ、Ｐａｗ、ＰｅｔＣＯ２显著增高（Ｐ＜０．０１），ＳｐＯ２显著下降（Ｐ＜０．０５）；随着机体的自身调节作用，２０分钟后，各指标与气腹前相比明显好转（Ｐ＞０．０５）。本文通过上述参数的观察，认为ＣＯ２气腹使腹内正压增加，膈肌上升，胸腔受到物理性压迫以及手术期间呼吸性酸中毒、缺氧、反应性交感神经刺激而致呼吸循环发生变化。故应强调术中呼吸循环的监测，尤其对有心肺疾病的患者；同时，应将腹内正压控制在１５～２０ｋＰａ［１］。One hundred consecutive patients who underwent laparoscopic cholecystectomy(LC) under general anesthesia were monitored with heart rate (HR), systolic blood pressure (SBP),SpO 2, airway pressure (Paw),end tidal carbon dioxide tension (PetCO 2) before and at intervals of 5,10 and 20 minutes respectively after CO 2 pneumoperitoneum (CP). The significant elevation of HR,SBP,Paw( P <0.01) and decline of SpO 2 ( P <0.05) occurred at 5, 10 minutes after CP, but all of the induce recovered ( P <0.05) at 20 minutes after CP. The authors consider that these changes of respiratory and circulatory induce result from the depression of the chest cavity by increased intra abdominal pressure and elevation of diaphnagm by CP, as well as the respiratory acidosis, hypoxia and the reflex sympathetic excitement which were caused by the operation. Therefore, the monitor of respiration and circulation must be emphasized during operation, especially in patients with lung and or heart diseases; and the intra abdominal pressure must be controlled in the range of 1.5～2.0 kPa.

关 键 词：二氧化碳气腹 腹腔镜 胆囊切除术 呼吸 循环 

分 类 号：R657.405[医药卫生—外科学]