气腹因素对行腹腔镜下子宫切除术麻醉患者的影响分析  

Analysis of the influence of pneumoperitoneum factors on anesthesia in patients undergoing laparoscopic hysterectomy

作　　者：王靖亚 刘凯月 Wang Jing-ya;Liu Kai-yue(Department of Anesthesiology,The Ninth People's Hospital of Zhengzhou,Zhengzhou 450053,China)

机构地区：[1]郑州市第九人民医院麻醉科,河南郑州450053

出　　处：《四川生理科学杂志》2024年第11期2548-2551,共4页

摘　　要：目的:研究气腹因素对行腹腔镜下子宫切除术的麻醉患者应激水平、胃肠功能及肺顺应性的影响。方法:选取2022年5月至2024年5月期间在本院进行腹腔镜下子宫切除手术的118例患者作为研究对象,按照随机数法分为低压组(n=39)、中压组(n=39)和高压组(n=40)。三组采用的气腹压力分别为6~8 mmHg、9~11mmHg和12~14 mmHg。分析对比两组的围手术期相关指标、血气指标(pH、PaO_(2)、PaCO_(2))、血清中D-乳酸水平、肺动态顺应性(Pulmonary dynamic compliance,Cdyn)水平、应激指标[心率(Heart rate,HR)、平均动脉压(Mean arterial pressure,MAP)、呼气末CO_(2)值(End-tidal carbon dioxide,ETCO_(2))、气道峰压值(Peak airway pressure,Ppeak)]以及并发症发生情况。结果:中压组和高压组患者的意识恢复及拔管所用时间、术后首次的排气时间、首次的排便时间、首次的进食时间及住院所用时间均明显长于低压组患者(P<0.05)。T3和T4时,中压组和高压组的pH、PaO2均比低压组明显降低,PaCO_(2)明显升高(P<0.05)。术后,中压组和高压组的血清D-乳酸水平均明显高于低压组(P<0.05)。T3时,高压组患者Cdyn水平明显低于低压组,HR、MAP、ETCO_(2)、Ppeak水平均明显高于低压组(P<0.05)。高压组患者苏醒期躁动及苏醒延迟的发生率均明显高于低压组(P<0.05)。结论:腹腔镜下子宫切除手术中采用较低的气腹压力可以明显抑制应激水平,降低对胃肠功能及肺顺应性的影响。Objective:To investigate the effects of pneumoperitoneum on stress level,gastrointestinal function and lung compliance in anesthesia patients undergoing laparoscopic hysterectomy.Methods:One hundred and eighteen patients who underwent laparoscopic hysterectomy in our hospital between May 2022 and May 2024 were selected for the study.According to the random number method,the patients were randomly divided into low-pressure group(39 cases),medium-pressure group(39 cases)and high-pressure group(40 cases).The pneumoperitoneum pressure of the three groups was 6~8 mmHg,9~11 mmHg and 12~14 mmHg,respectively.The perioperative relevant indexes,blood gas indexes(pH,PaO_(2),PaCO_(2)),serum D-lactic acid level,and pulmonary dynamic compliance(Cdyn)levels,stress markers[heart rate(HR),mean arterial pressure(MAP),end-expiratory CO_(2)(ETCO_(2)),airway peak pressure(Ppeak)]and the incidence of complications of the two groups were analyzed and compared.Results:The consciousness recovery time,extubation time,first exhaust,feeding time and postoperative hospitalization time in medium-pressure group and high-pressure group were significantly longer than those in low-pressure group(P<0.05).At T3 and T4,pH and PaO2 of medium-pressure group and high-pressure group were significantly lower low-pressure group,and PaCO_(2) was significantly higher than low-pressure group(P<0.05).After operation,serum D-lactic acid level in medium-pressure group and high-pressure group was significantly higher than that in low-pressure group(P<0.05).At T3,compared with low-pressure group,Cdyn level in high-pressure group was significantly decreased,while HR,MAP,ETCO_(2) and Ppeak levels were significantly increased(P<0.05).The incidence of restlessness and delayed recovery in high-pressure group was significantly higher than that in low-pressure group(P<0.05).Conclusion:Lower pneumoperitoneum pressure in laparoscopic hysterectomy can significantly inhibit the stress level and reduce the impact on gastrointestinal function and lung compliance.

关 键 词：气腹压力 应激水平 胃肠功能 肺顺应性 

分 类 号：R713.4[医药卫生—妇产科学]