后腹膜二氧化碳气腹对呼吸和循环功能的影响  

Effects of retroperitoneal carbon dioxide insufflation on the functions of the respiratory and circulatory system

作　　者：张云平[1] 卞平男[1] 郑庆国[1] 陈英强 陈艳 

机构地区：[1]徐州医学院附属第三医院麻醉科,江苏徐州221004 [2]东阳市横店集团医院麻醉科,浙江东阳

出　　处：《徐州医学院学报》2012年第9期583-586,共4页Acta Academiae Medicinae Xuzhou

摘　　要：目的观察后腹膜二氧化碳气腹对患者呼吸、循环功能的影响。方法将36例行腹腔镜手术的成年人分为后腹膜气腹组（A组）和腹膜气腹组（B组），每组18例，观察2组患者的呼吸力学和通气功能变化，同时根据血气分析情况得出肺泡-动脉氧分压差（PA—aDO2）、肺内分流率（Qs／QT）的值。同时有创监测及5例Hemosonic^TM血流动力学监护仪监测结果来观察血流动力学的变化。结果A组和B组患者的气道峰压都有升高，肺、胸顺应性都有下降，动脉血二氧化碳和呼气末二氧化碳也都有升高，但是A组和B组比较，A组变化更加明显（P〈0．01）；由于二氧化碳气腹对患者的物理方面和化学方面的影响使A组患者的心排血量减少和流出道阻力升高而影响循环功能，B组患者无明显变化（P〈0．01）。结论二氧化碳气腹对A、B两组患者的呼吸功能都有一定影响，表现在循环功能方面对A组患者有明显影响，对B组无明显影响。Objective To observe the effects of retroperitoneal carbon dioxide （ CO2 ） insufflation on the functions of the respiratory and circulatory system. Methods 36 adult patients underwent laparoscopie surgery were divided into retroperitoneal insufflation group （group A） and peritoneal insufflation group （group B） , with 18 cases in each group. Respiratory mechanics and ventilatory function were observed. A the same time, pulmonary alveolar - arterial oxygen difference （ PA - aDO2 ） and intrapulmonary shunt fraction （Qs/QT） were monitored using blood gas analysis. While hemodynamic parameters were monitored invasively, HemosonicTM hemodynamic monitor was used in 5 cases. Results Both group A and group B had increased peak airway pressure and decreased lung and chest compliance. Arterial CO2 and partial pressure of end - tidal CO2 also increased in group A and group B. But compared with group B, these parame- ters changed more obviously in group A （P 〈 0.01 ）. Due to the physical and chemical impact of CO2 pneumoperitoneum on the patients of group A, resulting in reduced cardiac output and increased outflow resistance, the function of circulatory system was affected in group A, while no significant changes of the function of circulatory system were observed in group B （ P 〈 0.01 ）. Conclion CO2 pneumoperitoneum can affect the respiratory function of both group A and group B. The function of circulatory system is affected obviously in group A, but not significantly affected in group B.

关 键 词：后腹膜腹腔镜 二氧化碳气腹 呼吸功能 循环功能 

分 类 号：R605[医药卫生—外科学]