高海拔地区后腹腔镜手术CO_2气腹对血气及血流动力学的影响  

The Influence of Retroperitoneal CO_2 Insufflation on Hemodynamics and Arterial Blood Gas in Retroperitoneoscopic Surgery at High Altitude Area

作　　者：朱明挺[1] 贾晶蓉 刘智明[1] 王国录[1] 乜国雁[1] 

机构地区：[1]青海省人民医院,810007

出　　处：《高原医学杂志》2016年第3期12-15,共4页Journal of High Altitude Medicine

摘　　要：目的:探讨高海拔地区后腹腔镜手术CO_2气腹对患者动脉血气及血流动力学的影响。方法:选择高海拔地区后腹腔镜手术患者91例,监测麻醉前(T1)、术前(气管插管后、气腹前)5min(T2)、术中(气腹开始)30min(T3)、术后(气腹结束、拔管)30min(T4),4个时段的血流动力学和动脉血气的变化。监测指标包括:心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、血酸碱度(p H)、动脉血二氧化碳分压(PCO_2)、动脉血氧分压(PO_2)、血浆碳酸氢盐(HCO-3)和血氧饱和度(Sa O_2)等。结果:术中(气腹开始)30min(T3)患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、血酸碱度(p H)、动脉血二氧化碳分压(PCO_2)均较麻醉前(T1)、术前(气管插管后、气腹前)5min(T2)、术后(气腹结束、拔管)30min(T4)有显著性差异(P<0.05)。结论:在高海拔低氧地区,后腹腔镜CO_2气腹对患者血流动力学和动脉血气有明显影响,动态监测血气分析及血流动力学各项指标,及时纠正酸碱平衡紊乱,预防高碳酸血症,以保证手术顺利、安全进行。Objective： To investigate the influence of retroperitoneal CO_2 insufflation on hemodynamics and arterial blood gas in retroperitoneoscopic surgery at high altitude area. Methods： 92 cases of patients who receiving retroperitoneoscopic urologic surgery were enrolled in this study. The hemodynamics and arterial blood gases were monitored at four points： preanesthesia（ T1）,five minutes before retroperioneal CO_2insufflation（ T2）,30 minutes after insufflation（ T3）,and 30 minutes after exsufflation（ T4）. The measured indexes included heart rate（ HR）,mean arterial pressure（ MAP）,central venous pressure（ CVP）,blood p H（ p H）,arterial carbon dioxide partial pressure（ PCO_2）,arterial partial pressure of oxygen（ PO_2）,plasma bicarbonate（ HCO-3） and oxygen saturation（ Sa O_2）. Results： Compared with other time points,patients at T3 point had significant difference in heart rate（ HR）,mean arterial pressure（ MAP） and central venous pressure（ CVP）（ P 0. 05）. Conclusion： Retroperitoneal CO_2 insufflation has an influence on hemodynamics and arterial blood gas in retroperitoneoscopic surgery at high altitude area,and it is necessary for dynamically monitor the associated indexes to keep the acid base balance and homeostasis for the success of retroperitoneoscopic surgery.

关 键 词：后腹腔镜手术 血气 血流动力学 CO2气腹 高海拔 

分 类 号：R656[医药卫生—外科学]