控制性过度通气在腹腔镜手术中的应用进展  

Progress of controlled hyperventilation in laparoscopic surgery

作　　者：代玲杰 袁清霞[2] DAI Lingjie;YUAN Qingxia(Department of Anesthesia,Yan’an University Affiliated Hospital,Yan’an,Shaanxi 716000,P.R.China;Department of Critical Care Medicine,Yan’an University Affiliated Hospital,Yan’an,Shaanxi 716000,P.R.China)

机构地区：[1]延安大学附属医院麻醉科,陕西延安716000 [2]延安大学附属医院重症医学科,陕西延安716000

出　　处：《华西医学》2020年第2期220-224,共5页West China Medical Journal

基　　金：延安市科技攻关项目(SL2019ZCSY-068)

摘　　要：随着腹腔镜在临床外科手术中的广泛应用,其术中出血少、切口小且美观、术后恢复快等优点日益凸显。然而,在腹腔镜手术中长时间使用二氧化碳(carbon dioxide,CO2)气腹或高CO2气腹压力可引起患者皮下气肿、高碳酸血症等,严重者可影响患者苏醒质量及预后。在全身麻醉腹腔镜手术过程中使用保护性通气策略-控制性过度通气的机械通气模式,可以降低或避免长时间的CO2气腹或高CO2气腹压力引起的高碳酸血症对机体的影响。该文就腹腔镜CO2气腹对机体的影响、控制性过度通气在全身麻醉腹腔镜手术中的应用以及控制性过度通气对机体的影响予以综述,旨在为促进控制性过度通气安全有效地运用于腹腔镜手术提供一定理论基础。With the extensive application of laparoscopy in clinical surgery,the advantages of laparoscopic surgery such as less intraoperative bleeding,small and beautiful incision,and rapid postoperative recovery become increasingly prominent.However,prolonged use of carbon dioxide(CO2)pneumoperitoneum or high CO2 pneumoperitoneum pressure during laparoscopic surgery may cause subcutaneous emphysema and hypercapnia,in severe cases which may affect the quality of recovery and prognosis of patients.The use of a protective ventilation strategy during laparoscopic surgery under general anesthesia,a mechanical ventilation model of controlled hyperventilation,can reduce or avoid the effects of hypercapnia caused by prolonged CO2 pneumoperitoneum or high CO2 pneumoperitoneum pressure.This article reviews the effects of laparoscopic CO2 pneumoperitoneum on patients,the application of controlled hyperventilation in laparoscopic surgery under general anesthesia and the effects of controlled hyperventilation on patients.The aim is to provide a theoretical basis for the safe and effective application of controlled hyperventilation in laparoscopic surgery.

关 键 词：过度通气 腹腔镜 二氧化碳气腹 高碳酸血症 

分 类 号：R614[医药卫生—麻醉学]