肥胖患者行妇科腹腔镜手术时PaO_2、PaCO_2与PETCO_2的变化  

Observation and analysis PaO_2,PaCO_2,PETCO_2 levels of obese patients underwent laparoscopic gynecological operation

作　　者：雷钟[1] 段惠洁[2] 刘亚华[1] 蒋晖[1] 

机构地区：[1]新疆医科大学附属肿瘤医院麻醉科,乌鲁木齐830011 [2]新疆医科大学附属肿瘤医院内二科,乌鲁木齐830011

出　　处：《新疆医科大学学报》2013年第2期223-226,共4页Journal of Xinjiang Medical University

基　　金：新疆医科大学科研创新基金(XJC201036)

摘　　要：目的观察肥胖患者行妇科腹腔镜手术时动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)与呼末二氧化碳分压(PETCO2)的变化特点。方法选择2011年3-10月在新疆医科大学附属肿瘤医院择期行妇科腹腔镜手术的肥胖患者15例(试验组),同期接受妇科腹腔镜手术治疗的正常体重患者15例(对照组)。术中采用静吸复合全身麻醉,分别于气管插管后约5min、手术前(T0)、行头低臀高位后10min(T1)、行头低臀高位后30min(T2)及拔管后5min(T3)抽取动脉血行血气检测,比较两组患者在不同时点的气道峰压(PIP)、肺顺应性(Clt)、PaO2、PaCO2、PETCO2、pH值及动脉血HCO3-的变化。结果麻醉后试验组患者气道峰压明显高于对照组(P<0.05);两组患者肺顺应性差异无统计学意义(P>0.05);两组患者麻醉后各时点PETCO2差异无统计学意义(P>0.05);试验组PaO2明显低于对照组(P<0.05);术中两组患者PaCO2呈上升趋势,试验组T1、T2时点PaCO2明显低于对照组(P<0.05);两组患者动脉血HCO3-均未随着手术时间的延长而发生明显变化(P>0.05),但试验组患者拔管后动脉血HCO3-明显高于对照组(P<0.05)。结论在相同的通气模式下,两组患者术中随着手术时间的延长PaCO2、PETCO2均呈上升趋势,但肥胖患者较正常体质量患者变化缓慢,两组患者动脉血pH值均随手术时间的延长而逐渐下降。肥胖患者术中PaO2较正常体质量患者低。术后拔出气管导管后,肥胖患者在短时内PaCO2升高、PaO2降低较显著,应加强对肥胖患者拔管后的观察、护理。Objective To observe the arterial oxygen tension （PaO2）, arterial carbon dioxide tension （PaCO2） and end-tidal pressure of carbon dioxide （PETCO2） change characteristics in obese patients who underwent laparoscopic gynecological operation. Methods Fifteen cases of obesity who received laparoscopic gynecologic surgery in Affiliated Tumor Hospital of Xinjiang Medical University from March 2011 to October 2011, 15 cases with obesity was as experimenta! group, 15 patients with normal body weight were elected as control group who received laparoscopic gynecologic surgery in the same period. Inhalation --intravenous general anesthesia during surgery. Record the PETCO2 value and extraction of arterial blood for blood gas detection after tracheal intubation about five minutes （T0）, after Trendelenburg position ten minutes （T1）, after Trendelenbu minutes （T3）, different points in rg th position thirty minutes （T2）, after pull aut the tracheal catheter five e peak airway pressure （PIP）, pulmonary compliance （CLT）, PaO2, PaCO2, PETCO2, pH and HCO3 changes in arterial blood were compared between two groups of patients. Results Anesthesia in obese patients with airway peak pressure was higher than that in the control group （P 〈0.05）. The lung compliance was no statistically significant difference between two groups （P 〈0. 05）. After anesthesia to the observation of PETCO2 showed no statistically significant difference either. Obesity group of patients with PaO2 was lower than control group （P〈0.05）. Two groups of patients showed ascendant trendon PaCO2, But on the T1 and T2 moment in obesity group PaCO2 was lower than control group. Two groups of patients were not changed obviously on arterial blood HCO;- （P〉0.05）. But the obese group arterial blood HCO3 rose obviously after extubation, the difference was statistically significant （P %0.05）. Conclusion In the same ventilation mode, PaCO2 and PETCO2 all shows ascend ant trend with prolonged operative time, but ob

关 键 词：肥胖 腹腔镜 动脉血气 PETCO2 

分 类 号：R614.2[医药卫生—麻醉学]