妇科腹腔镜与开腹手术对围手术期血气的影响  

Influences of gynecological laparoscopy and laparotomy on perioperative blood gas of the patient

作　　者：瞿晓燕[1] 程忠平[2] 朱宇[2] 胡莉萍[2] 戴虹[2] 康乐[2] 

机构地区：[1]温州医学院,浙江温州325035 [2]上海市杨浦区中心医院,上海200090

出　　处：《中国妇幼健康研究》2009年第1期55-57,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的比较妇科腹腔镜手术和开腹手术对患者血气、酸碱平衡的影响，旨在提高腹腔镜手术的安全性。方法比较63例腹腔镜手术（腹腔镜组）与54例开腹手术（开腹组）术前、术后即时、术后6小时抽取2mL股动脉血行血气分析。结果两组各项血气指标在术前比较均无显著性差异（P〉0．05）。开腹组的各项血气指标术后与术前相比无显著性差异（P〉0．05）。腹腔镜组术后6小时各项指标基本恢复术前水平，与术前比较无显著性差异（P〉0．05）。腹腔镜组术后即时动脉血二氧化碳分压则明显高于开腹组，经比较有显著性差异（P〈0．05），但动脉血氧分压、动脉血氧饱和度无明显差异；腹腔镜组术后即时酸碱度、剩余碱明显低于开腹组，经比较有显著性差异（P〈0．05），腹腔镜组术后即时碳酸氢根低于开腹组，但无统计学意义（P〉0．05）。结论妇科腹腔镜手术对患者血气虽有一定的影响，但如能做好充分的术前准备，加强围手术期监测，尽量缩短手术时间，血气变化仍在正常范围内。Objective To compare influences of gynecological laparoscopic operation and laparotomy on blood gas and acid-base balance of the patient so as to improve safety of laparoscopic operation. Methods 2mL of blood samples from femoral artery of 63 patients who underwent laparoscopic operation and 54 patients who underwent open-abdomen operation （ laparotomy ） were taken and examined for blood gas analysis for three times： before operation, immediate starting of the operation （within 10 minutes after starting of the operation）, 6 hours after the operation. Results In all blood gas indexes, there were no significant differences between the two groups before operation （P 〉 0.05）. In all blood gas indexes of the patients in open-abdomen group, there were no significant differences before and after operation （P 〉 0.05 ）. In laparoscopy group, all blood gas indexes at 6 hours after operation recovered basically to the levels before op.eration and there were no significant differences （ P 〉 0.05 ）. The immediate postoperative PaCO2 of the patients in the laparoscopy group was significantly higher than the open-abdomen group, and there was a significant difference （P 〈 0.05 ）, but in PaO2 and SaO2, there were no significant differences between the two groups. The immediate postoperative pH, BE of the patients in the laparoscopy group were significantly lower than open-abdomen group and there were significant differences （ P 〈 0.05 ）, and immediate postoperative HCO3 - in the laparoscopy group was also lower than open-abdomen group, but there was no significant difference （P 〉 0. 05 ）. Conclusion Although laparoscopic operation can affect blood gas and acid-base balance at some extent, if pre-operation preparation is perfect, perioperative monitoring is intensified and operation time is shortened as possible, blood gas would be kept in normal range.

关 键 词：腹腔镜手术 开腹手术 血气分析 酸碱平衡 

分 类 号：R713[医药卫生—妇产科学]