呼末二氧化碳分压监测在后腹腔镜手术中的作用  

Effect of end-tidal carbon dioxide pressure monitoring in retroperitoneoscopyic surgery

作　　者：张红艳[1] 陈文定[2] 赵黎丽[1] 

机构地区：[1]南昌大学第一附属医院麻醉科,南昌330006 [2]浙江大学医学院附属妇产科医院,杭州310006

出　　处：《中华腔镜泌尿外科杂志（电子版）》2012年第5期45-48,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：江西省卫生厅科技计划项目(20061071)

摘　　要：目的探讨呼末二氧化碳分压(PETCO2)监测在后腹腔镜手术中的作用。方法回顾分析72例择期行后腹腔镜手术的患者,依据PaCO2监测结果将患者分为两组,A组:各监测时点PaCO2<60mmHg;B组:气腹后至少有一个时间点PaCO2>60mmHg。分别于气腹前(T1)、气腹后30min(T2)、60min(T3)、90min(T4)时记录各时间点的PaCO2、PETCO2,根据PETCO2及PaCO2计算每个时间点的Pa-ETCO2。结果两组间比较:T1、T2时间点B组患者的PaCO2、PETCO2、Pa-ETCO2较A组无统计学差异(P>0.05),T3、T4时间点B组患者的三项监测指标较A组有统计学差异(P<0.05)。两组组内比较:A组,T2-4与T1相比较,PaCO2、PETCO2、Pa-ETCO2均有统计学差异(P<0.05),T3与T2、T4与T3、T4与T2比较三项监测指标均无统计学差异(P>0.05);B组,T2-4与T1相比较,PaCO2、PETCO2、Pa-ETCO2均有统计学差异(P<0.05或P<0.01),随着气腹时间的延长,PaCO2、PETCO2两项监测指标均逐渐升高,T3与T2、T4与T3、T4与T2比较PaCO2有统计学差异(P<0.05),PETCO2T4与T2比较有统计学差异(P<0.05)。结论后腹腔镜手术气腹后患者的PaCO2、PETCO2、Pa-ETCO2均会升高,尤其是体重指数>30kg/m2、术前肺功能检查轻至中度阻塞性通气障碍、术中发生皮下气肿的患者,PaCO2、PETCO2随时间的延长而呈进行性升高,单靠PETCO2监测不能完全满足对患者的监测需要,术中应该辅以动脉血气分析监测PaCO2。Objective To study the value of end-tidal carbon dioxide pressure monitoring in retroperitoneoscopyie surgery. Methods Seventy-two patients scheduled for retroperitonesocopy were retrospectively studied. The patients were divided into two groups according to the level of PaCO2. Group A： PaCO2 was not surpassed 60 mmHg after CO2 insufflation. Group B： PaCO2 was surpassed 60 mmHg at one or more time point after CO2 insufflation. Before pneumoperitoneum （T1）, 30 （T2）, 60 （T3） and 90 rain （T4） after CO2 insufflation PaCO2 and PETCO2 were recorded witj PETCO2 was calculated at each time according to PaCO2 and PETCO2. Results Group B compared with group A： At TI and T2, PaCO2, PrrCO2 and PaETCO2 in group B showed no significant difference compared with group A （P〉0.05）, At T3 and T4, the three parameters of monitoring in group B showed significant differences compared with group A （P〈0.05）. Between-group comparison： In group A, T2-4 compared with T1, PaCO2, PETCO2, PETCO2 were significanly lower （P〈0.05）. T3 compared with T2, T4 compared with T3, T4 compared with T2, three parameters of monitoring showed no significant difference （P〉 0.05）. In group B, T2-4compared with T,, PaCO：, PETCO2 PETCO2 were significanly lower （P〈0.05 or P〈0.01）. PaCO2 and PETCO2 gradually increased with pneumoperitoneum time, T3 compared with T2, T4 compared with T3, T4 compared with T2, PaCO2 showed significantly different （P〈0.05）, T4 compared with T2, PETCO2 showed significantly different （P〈0.05）. Conclusions PaCO2, PETCO2, P, _ErCOz increased after CO2 insufflation during retroperitoneoscopyic surgery. Particularly for thosepatients, who were body mass index 〉30 kg/m2, mild to moderate obstructive ventilatory defect showed in preoperative pulmonary function tests, with subcutaneous emphysema in surgery, PaCO2 and PETCO2 progressively increased with time after CO2 insuttlation. PETCO2 monitoring couldn＇t meet the need of monitoring. Arterial gas analysis monitoring P

关 键 词：呼末二氧化碳分压 后腹腔镜手术 

分 类 号：R656[医药卫生—外科学]