固定通气模式下老年患者后腹膜腔镜手术中Pa-etCO_2变异性及与酸碱环境的相关性研究  

Correlation Analysis of the Pa-etCO_2 Variability and Acid-base Environment in Elderly Patients Undergoing Retroperitoneal Laparoscopic Surgery under Fixed Ventilation Mode

作　　者：陈涵[1] 伍静[1] 陈向东[1] 姚尚龙[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院麻醉科,武汉430022

出　　处：《华中科技大学学报（医学版）》2016年第4期441-444,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金青年基金资助项目(No.30801076)

摘　　要：目的观察老年患者行后腹膜腔镜手术时Pa-etCO_2的变异性,探讨Pa-etCO_2与酸碱环境的相关性。方法选择40例固定通气模式全麻下行后腹膜腔镜手术的患者,按年龄分为A组(60~80岁)和B组(20~未满60岁)各20例,ASAⅠ~Ⅱ级,分别记录诱导后15min(T1),气腹后15min(T2),气腹后30min(T3),气腹后60min(T4),停气腹后15min(T5)的PetCO_2、Ppeak,并抽取动脉血行血气分析,记录PaCO_2、pH值、HCO_3^-值,并计算Pa-etCO_2。结果 1两组患者在气腹后Pa-etCO_2、PetCO_2和Ppeak均明显增大且差异有统计学意义(均P<0.05)。Pa-etCO_2增加的程度随着手术时间的延长加大,且A组增加的程度明显高于B组(均P<0.05);PetCO_2和Ppeak均不随手术时间的延长继续增加。两组的Pa-etCO_2分别与PetCO_2和Ppeak都没有明显的相关性。2两组患者气腹后pH值及HCO_3^-值均较气腹前降低,差异有统计学意义(均P<0.05),但A、B组间无差异(均P>0.05)。两组Pa-etCO_2在气腹后与pH值均明显呈负相关。两组pH值与HCO_3^-值均有相关性(P<0.01)。结论老年患者后腹膜腔镜手术中Pa-etCO_2变异性较年轻患者随时间明显增加,且与内环境酸碱失衡有很好的相关性,会引起不可避免的pH值及HCO_3^-值的降低,但不能用PetCO_2和Ppeak来准确判断PaCO_2的变化。Objective To observe the Pa-etCO2 variability in elderly patients undergoing retroperitoneal laparoscopic surgery,and examine the correlation between Pa-etCO2 and acid-base environment.Methods Forty patients（ASAⅠ-Ⅱ）who underwent retroperitoneal laparoscopic surgery under general anesthesia and fixed ventilation mode were divided into two groups according to the age：group A（60—80years old）and group B（20—60years old）.PetCO2 and Ppeak were recorded 15 min after intubation,15,30,60 min after CO2 insufflation and 15 min after desufflation,respectively.An arterial blood gas test was performed to obtain the values of PaCO2,pH value,and HCO3^- and then calculate Pa-etCO2.Results①Pa-etCO2,PetCO2 and Ppeak were significantly increased in both group A and group B after CO2insufflation（P〈0.05）.Pa-etCO2 was elevated with the time of operation,and it increased significantly faster in group A than in group B（P〈0.05）.PetCO2 and Ppeak did not continue to increase with the extension of the operation.No correlation was found between Pa-etCO2 and PetCO2 or Ppeak.②pH and HCO3^- were significantly decreased after CO2 insufflation（P〈0.05）,but no difference was found in pH and HCO3^- between groups（P〉0.05）.There was a negative correlation between Pa-etCO2 and pH,and a positive correlation between pH and HCO3^- in both groups（P〈0.01）.Conclusion Pa-etCO2 was significantly increased with the extension of the operation in elderly patients undergoing retroperitoneal laparoscopic surgery as compared with their younger counterparts,leading to an inevitable decrease of pH and HCO3^- .There is a close association between Pa-etCO2 and acid-base environment.It is not suitable to use PetCO2 and Ppeak to accurately evaluate the changes of PaCO2 in elderly patients.

关 键 词：后腹膜腔镜手术 动脉血-呼气末二氧化碳分压差 变异性 酸中毒 相关性 

分 类 号：R614[医药卫生—麻醉学]