压力梯度控制方案对妇科腹腔镜手术患者二氧化碳气腹早期阶段循环呼吸功能影响的研究  

Effects of pressure gradient controlon circulatory and respiratory function in early stage of carbon dioxide pneumoperitoneum in patients with gynecological laparoscopic surgery

作　　者：吴延华[1] 王琰[1] 徐昌霞[1] 肖蕾[1] 吴炜[1] 於春燕[1] 张小敏[1] 陈欢欢 Wu Yanhua;Wang Yan;Xu Changxia;Xiao Lei;Wu Wei;Yu Chunyan;Zhang Xiaomin;Chen Huanhuan(Department of Operating Room,Jiangsu Traditional Chinese Medicine Hospital,Nanjing 210029,China)

机构地区：[1]江苏省中医院手术室,南京210029

出　　处：《中国实用护理杂志》2020年第25期1921-1926,共6页Chinese Journal of Practical Nursing

基　　金：江苏省中医院2018年医院创新发展基金专项课题(Y2018CX42)。

摘　　要：目的探讨压力梯度控制方案对妇科腹腔镜手术患者二氧化碳(CO_(2))气腹早期阶段循环呼吸功能的影响。方法选取江苏省中医院2018年11月1日至2019年3月31日择期手术的妇科腹腔镜手术患者100例作为研究对象,采用随机数字表法分为试验组和对照组,每组50例,试验组采用压力梯度控制的方法建立CO_(2)气腹,即将气腹压力设为5、9、12 mmHg(1 mmHg=0.133 kPa)逐渐上升3个梯度,并在到达相应的梯度后分别维持1 min直至12 mmHg;对照组采用常规方法,即将气腹压力直接设置为12 mmHg,开始充气直至到达预设压力。观察2组气腹前与气腹后15 min内的循环呼吸指标收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、呼吸末CO_(2)分压(P_(ET)CO_(2))、气道峰压(P_(peak))、动脉血CO_(2)分压(PaCO_(2))的改变情况以及循环呼吸干预的情况。结果试验组气腹后15 min内SBP、DBP、MAP、HR、P_(ET)CO_(2)、P_(peak)、PaCO_(2)最大值分别为(117.08±13.07)mmHg、(77.08±9.43)mmHg、(90.06±10.33)mmHg、(69.04±9.10)次/min、(36.00±3.37)mmHg、(20.18±2.74)cmH_(2)O(1 cmH_(2)O=0.098 kPa)、(40.65±3.31)mmHg,对照组分别为(140.63±18.34)mmHg、(91.90±11.79)mmHg、(107.25±12.85)mmHg、(77.67±13.57)次/min、(38.31±4.31)mmHg、(24.81±4.26)cmH_(2)O、(45.19±4.49)mmHg,2组比较差异有统计学意义(t值为-7.269~-2.945,均P<0.01)。试验组气腹前后SBP、DBP、MAP、HR、P_(ET)CO_(2)、P_(peak)、PaCO_(2)波动幅度分别为(10.14±6.34)mmHg、(8.98±5.88)mmHg、(9.14±5.44)mmHg、(5.80±2.48)次/min、(3.27±1.43)mmHg、(2.65±1.54)cmH_(2)O、(4.08±1.74)mmHg,对照组分别为(33.65±14.87)mmHg、(26.17±9.73)mmHg、(28.04±9.97)mmHg、(17.63±9.77)次/min、(6.98±2.89)mmHg、(7.44±2.35)cmH_(2)O、(9.52±3.92)mmHg,2组比较差异有统计学意义(t值为-11.841~-8.048,均P<0.01)。气腹后15 min内,试验组循环干预情况4.08%(2/49),低于对照组的22.92%(11/48),差异有统计学意义(χ^(2)值为7.412,P<0.01),试验Objective To investigate the effects of pressure gradient controlled carbon dioxide(CO_(2))pneumoperitoneum establishment in patients with gynecological laparoscopic surgery on early circulatory and respiratory function.Methods From November 1,2018 to March 31,2019,100 case of gynecological laparoscopic surgery who were scheduled to undergo elective surgery in Jiangsu Hospital of Traditional Chinese Medicine were enrolled and divided into experimental group(50 cases)and control group(50 cases)by random number table method.The experimental group used pressure gradient control method to establish CO_(2) pneumoperitoneum,that is,the pneumoperitoneum pressure was set to 5,9,12 mmHg(1 mmHg=0.133 kPa)gradually rising three gradients,and after reaching the corresponding gradient,they were maintained for 1 minute to 12 mmHg;the control group used conventional method,that was,the pneumoperitoneum pressure was set directly to 12 mmHg,and began to inflate until reaching the preset pressure.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR),end-of-breath partial pressure of CO_(2)(P_(ET)CO_(2)),peak airway pressure(P_(peak)),arterial blood partial pressure of CO_(2)(PaCO_(2))and the intervention of cirulation and respiration were compared between the two groups before and within 15 minutes after pneumoperitoneum.Results The max values of SBP,DBP,MAP,HR,P_(ET)CO_(2),P_(peak) and PaCO_(2) within 15 minutes after pneumoperitoneum in the experimental group were(117.08±13.07)mmHg,(77.08±9.43)mmHg,(90.06±10.33)mmHg,(69.04±9.10)times/min,(36.00±3.37)mmHg,(20.18±2.74)cmH_(2)O(1 cmH_(2)O=0.098 kPa),(40.65±3.31)mmHg,higher than that of the control group(140.63±18.34)mmHg,(91.90±11.79)mmHg,(107.25±12.85)mmHg,(77.67±13.57)times/min,(38.31±4.31)mmHg,(24.81±4.26)cmH_(2)O,(45.19±4.49)mmHg,the differences were statistically significant(t values were-7.269--2.945,all P<0.01).The amplitudes of SBP,DBP,MAP,HR,P_(ET)CO_(2),P_(peak) and PaCO_(2) fluctuations before and after pneumo

关 键 词：腹腔镜 气腹 妇科腹腔镜手术 呼吸循环功能 

分 类 号：R713[医药卫生—妇产科学]