胸乳入路腔镜甲状腺手术二氧化碳充气对脑氧供需平衡的影响  

Effects of CO_2 insufflation on cerebral oxygen supply-demand balance during via breast approach laparoscopic thyroidectomy

作　　者：丛风云[1] 谢闽众 张志甫[1] 林南[1] 

机构地区：[1]广西民族医院普通外科,广西南宁530001

出　　处：《右江民族医学院学报》2016年第5期504-506,共3页Journal of Youjiang Medical University for Nationalities

基　　金：广西壮族自治区卫生厅自筹经费科研课题(Z2014179)

摘　　要：目的探讨腔镜下胸乳入路甲状腺手术二氧化碳(CO2)充气对脑氧供需平衡的影响。方法腔镜下行胸乳入路甲状腺手术患者30例,分别于CO2充气前,充气后10min、20min、40min和关闭充气后5min、20min,抽取颈静脉球血和桡动脉血进行血气分析,比较不同时点动、静脉血气及脑动一静脉血氧含量差(Ca-jvDO2)的变化。结果颈内静脉血氧分压(PjvO2)、颈内静脉血氧饱和度(SjvO2)在充气后各时间点与充气前相比显著上升(P<0.05);Ca-jvDO2在充气后各时间点与充气前相比显著下降(P<0.05);动脉血乳酸(aLac)、颈内静脉乳酸(jvLac)在充气后各时间点与充气前相比差异无统计学意义(P>0.05)。结论腔镜下胸乳入路甲状腺手术CO2充气后,脑血流量显著增加,脑组织无氧代谢增加的情况未发现。Objective To observe the effects of CO 2 insufflation on cerebral oxygen supply-demand bal-ance during via breast approach laparoscopic thyroidectomy. Methods Thirty patients undergoing via breast approach laparoscopic thyroidectomy were selected.Blood samples from artery and jugular vein were collected for blood gas analysis before the CO 2 insufflation,at intervals of 10 min,20 min and 40 min after the insuffla-tion,and at intervals of 5 min,20 min after the cessation of insufflation respectively.The changes of arterial and venous blood gas,and of the difference between cerebral arterial and venous oxygen content （Ca-jvDO 2 ）were compared at different time points. Results Compared with pre-insufflation,post-insufflation PjvO 2 and Sj-vO 2 were significantly increased at each point （P 〈0.05）,while the Ca-jvDO 2 decreased significantly （P 〈0.05）.There was no significant difference in the aLac and jvLac at each time points after CO 2 insufflation by comparing to pre-insufflation （P〉0.05 ）. Conclusion After CO 2 insufflation during via axillary laparo-scopic thyroidectomy,cerebral blood flow increases significantly,and there is no evidence of the increasing of cerebral anaerobic metabolism.

关 键 词：甲状腺切除术 二氧化碳 氧 脑血流 

分 类 号：R653[医药卫生—外科学]