CO_2气腹对后腹腔镜手术患者血压、心率及CO_2排除量的影响  

Effects of CO_2 pneumoperitoneum on blood pressure,heart rate and depletion rate of CO_2 in the patients undergoing retroperitoneoscopic operation

作　　者：刘秀珍[1] 魏昌伟[1] 王卓强[1] 徐震[1] 张斌[1] 王恒林[1] 陈绪贵[1] 

机构地区：[1]解放军309医院麻醉科,北京100091

出　　处：《解放军医学杂志》2010年第3期316-318,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的观察CO2气腹对接受后腹腔镜手术患者术中血压、心率(HR)及CO2排除量的影响。方法选取85例择期手术患者,其中后腹腔镜下行根治性肾癌切除手术患者(A组)45例,腹腔镜下行子宫全切或全子宫并双附件切除手术患者(B组)40例。监测并记录插管后气腹前(T1)、气腹后15min(T2)、气腹后30min(T3)、气腹后45min(T4)、气腹后60min(T5)的HR、平均动脉压(MAP)、中心静脉压(CVP)、动脉血二氧化碳分压(PaCO2)以及不同手术时段机体对CO2的排除量。结果与气腹前比较,两组患者在气腹后的各时段HR、MAP、CVP均明显增加(P<0.05),但两组间比较无显著性差异(P>0.05)。与气腹前比较,两组PaCO2和CO2排除量在气腹后的各时段均明显增加(P<0.05),且A组在T4、T5时段明显高于B组(P<0.05)。结论CO2气腹对后腹腔镜与腹腔镜手术患者的血压、HR等有一定的影响,但后腹腔镜手术比腹腔镜手术更容易引起高碳酸血症,术中需加强PaCO2的监测。Objective To observe the effects of CO2 pneumoperitoneum on blood pressure, heart rate （HR） and depletion rate of CO2 in patients undergoing retroperitoneoscopic operation. Methods Eighty-five patients undergone selective operation were involved in present study. Of them 45 underwent radical resection of kidney cancer with retroperitoneoscopy （group A）, and 40 underwent laparoscopic hysterectomy or hysterectomy and removal of bilateral appendages （group B）. The HR, mean arterial pressure （MAP）, central venous pressure （CVP）, and arterial carbon dioxide partial pressure （PaCO2） of patients in both groups were monitored and recorded before pneumoperitoneum （T1） and 15min （T2）, 30min （T3）, 45min （T4） and 60min （T5） after pneumoperitoneum. The depletion of CO2 in different time point of operation was calculated based on formula. Results HR, MAP and CVP were significantly increased after pneumoperitoneum than before pneumoperitoneum in both groups （P0.05）, while no significant difference was found in HR, MAP and CVP at each time point between the two groups （P0.05）. PaCO2 and CO2 depletion rate was significantly increased after pneumoperitoneum than pre-pneumoperitoneum in both groups （P0.05）, while no significant difference existed in PaCO2 and CO2 depletion rate between the two groups at T1, T2 and T3 time points （P0.05）. Compared with group B, the PaCO2 and CO2 depletion rate in group A increased obviously at T4 and T5 time point （P0.05）. Conclutions CO2 pneumoperitoneum has certain effect on blood pressure and heart rate of patients undergoing retroperitoneoscopic and laparoscopic operations. However, retroperitoneoscopic operation may induce higher PaCO2 and hypercapnia than laparoscopic operation. Monitoring of arterial carbon dioxide pressure should be strengthened during these operations.

关 键 词：气腹 人工 后腹腔镜手术 腹腔镜检查 血流动力学现象 

分 类 号：R614.2[医药卫生—麻醉学]