侧卧位腹膜后气腹对动脉血-呼气末二氧化碳分压差的影响  

Effects of retroperitoneal insufflation on arterial-end carbon dioxide partial pressure at lateral position

作　　者：罗中兵[1] 张燕辉[1] 宋晓阳[1] 杨俊哲[1] 陶军[1] 

机构地区：[1]广州军区武汉总医院麻醉科

出　　处：《临床外科杂志》2015年第6期454-456,共3页Journal of Clinical Surgery

摘　　要：目的：观察侧卧位腹膜后气腹对动脉血-呼气末二氧化碳分压差（Pa-ET CO2）的影响，为麻醉过程中调节呼吸机参数提供参考。方法选择侧卧位下行腹膜后腹腔镜手术患者28例， ASA 分级Ⅰ～Ⅱ级。术中持续监测呼气末二氧化碳分压，在气腹前平卧位时、气腹前侧卧位时、气腹后30 min、60 min 和90 min 时行动脉血气分析，计算 Pa-ET CO2。结果气腹前平卧位的 Pa-ET CO2低于气腹前侧卧位[（3．1±2．8）mmHg 比（7．3±2．6）mmHg，P ＜0．05]。气腹后30 min、60 min 和90 min 的 Pa-ET CO2无显著差异[（9．1±3．1）mmHg、（9．2±3．9）mmHg、（8．9±4．1）mmHg，P ＞0．05]，但均高于气腹前平卧位和侧卧位（P ＜0．05）。结论侧卧位下腹膜后气腹因体位和气腹的影响而增加 Pa-ET CO2，术中需防止酸中毒，降低 PET CO2值。Objective To observe effects of retroperitoneal insufflation on arterial-end carbon di-oxide partial pressure（Pa-ET CO2 ）at lateral position and offer references to parameter regulation of respira-tor in anesthesia.MethodsA total of 28 patients（ASA I ~II grade）with retroperitoneoscopy were enrolled. End-tidal carbon dioxide partial pressure（PET CO2 ）was continuously monitored during operation.Blood-gas analysis was performed at the time points of supine position before insufflation,lateral position before in-sufflation,30 min,60 min,and 90 min after insufflation and the PET CO2 was calculated.Results The Pa-ET CO2 at supine position before insufflation was significantly lower than that at lateral position[（3.1 ± 2.8）mmHg vs（7.3 ±2.6）mmHg,P 〈0.05].There were no statistical differences in Pa-ET CO2 at 30 min, 60 min,90 min after insufflation during lateral position[（9.1 ±3.1 ）mmHg,（9.2 ±3.9）mmHg,（8.9 ± 4.1 ）mmHg,P 〉0.05],but they were all higher than those at supine position and lateral position before insufflation（P 〈0.05）.Conclusion During the retroperitoneal insufflation at lateral position,Pa-ET CO2 is increased by position and insufflation.To prevent the incidence of acidosis,PET CO2 should be decreased during retroperitoneal insufflation at the lateral position.

关 键 词：腹膜后腹腔镜 呼气末二氧化碳分压 动脉血二氧化碳分压 麻醉 血气分析 

分 类 号：R614[医药卫生—麻醉学]