加压胸带预防腹腔镜皮下气肿的临床研究  

The clinical study of the effect of pressurized chest strap on preventing subcutaneous emphysema during laparoscopic surgery

作　　者：冯梅[1] 赵桂林[1] 蒋宗滨[1] 蒋小青[1] 路双福 张明明[1] 

机构地区：[1]广西医科大学第一附属医院西院手术室麻醉科,南宁市530007

出　　处：《临床麻醉学杂志》2014年第9期893-896,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察加压胸带对腹腔镜下完全腹膜外疝修补术中皮下气肿程度及CO2吸收的影响。方法选择行全麻腹腔镜下完全腹膜外疝修补术患者60例,年龄60～80岁。按随机数字表法分为观察组和对照组,每组30例。前者于入室后麻醉前开始采用加压胸带处理,后者不做任何处理。记录麻醉前(T0)、气腹前5min(T1)、气腹后30min(T2)、60min(T3)、放气腹后15min(T4)和60min(T5)的SBP、DBP、HR、SpO2、气道峰压(Ppeak)、VE、肺顺应性(Compl)和血气分析,并记录术后皮下气肿发生程度等。计算CO2排出率(VCO2)。结果与T0时比较,T2～T5时对照组SBP、DBP、PaCO2均明显升高,HR明显增快,pH明显降低(P<0.05);与T1时比较,T2、T3时两组Ppeak、VCO2和VE均明显升高,T4时对照组VCO2和VE明显升高(P<0.05或P<0.01)。与对照组比较,T2～T5时观察组HR明显减慢,SBP、DBP和PaCO2明显降低,pH明显升高(P<0.05);观察组T2、T3时Ppeak明显降低,T2～T4时VCO2及VE明显降低(P<0.05或P<0.01)。与对照组比较,观察组皮下气肿较严重,清醒时间及拔管时间均明显缩短(P<0.05)。结论加压胸带能有效地预防腹腔镜手术中皮下气肿,减轻高碳酸血症及呼吸性酸中毒,对呼吸循环功能影响较小。Objective To investigate the effects of pressurized chest strap on subcutaneous emphysema and the absorption of CO2 during laparoscopic hernia repair.Methods Sixty patients（60-80 years old）undergoing elective laparoscopic totally extraperitoneal hernia repair were randomly divided into two groups（n=30each）,experimental group（with pressurized chest strap）and contorl group（received no special treatment）.HR,BP,CO2 discharge rate,mechanical ventilation parameters were recorded before anesthesia（T0）,before CO2insufflation（T1）,at 30min（T2）and 60min（T3）after CO2 insufflation,at 15min（T4）and 60min（T5）after CO2 desufflation.Subcutaneous emphysema was also recorded after operation.Results In the control group,the SDP,DBP,HR and PaCO2 elevated significantly while the pH value decreased at T2-T5 compared with T0（P〈0.05）.In the both groups,the Ppeak,VO2 and VEincreased at T2,T3 compared with T1（P〈0.05 or P〈0.01）.The VCO2 and VEstill increased at T4 in the control group（P〈0.05 or P〈0.01）.Compared with the control group,the SDP,DBP,HR and PaCO2 decreased while the pH value increased at T2-T5 in the experimental group（P〈0.05）.The Ppeak at T2,T3 and the VCO2 and VEat T2-T4 decreased significantly in the experimental group（P〈0.05 or P〈0.01）.In the control group,the subcutaneous emphysema was more severe（P〈0.05）.The waking hours and extubating hours were longer too（P〈0.05）.Conclusion Pressurized chest strap can effectively prevent the subcutaneous emphysema in laparoscopic surgery,attenuated hypercapnia and respiratory acidosis,and it also has less influence on respiratory and circulatory function.

关 键 词：腹腔镜 二氧化碳 胸带 高碳酸血症 

分 类 号：R656[医药卫生—外科学]