后腹腔镜手术CO_2气腹对中度高原地区患者血气的影响  

The influence of CO_2 pneumoretroperitoneum on arterial blood gas in patients undergoing urological laparoscopic surgeries in moderate altitude region

作　　者：李世江[1] 于波锋[1] 李家平[1] 高华[1] 王绍丽[1] 陆伟玲[1] 石红梅[1] 巩会杰[2] 闫永吉[2,3] 

机构地区：[1]玉溪市中医医院外二科,云南玉溪653100 [2]北京中医药大学东直门医院泌尿外科 [3]昆明医科大学第二附属医院泌尿外科三病区

出　　处：《微创泌尿外科杂志》2015年第3期143-145,共3页Journal of Minimally Invasive Urology

基　　金：云南省应用基础研究(2013FB163)

摘　　要：目的:观察后腹腔镜手术中CO2气腹对处于中度高原地区的泌尿外科患者血气的影响。方法:2012年1月~2014年10月对云南省玉溪地区35例泌尿外科患者行后腹腔镜手术。其中男22例,女18例,年龄23~62岁,平均48岁。术中CO2气腹压力维持在1.596~1.862kPa(12~14mm Hg)。设立3个监测时间点,分别于气腹建立0、30和60min检测动脉血酸碱度(pH)、二氧化碳分压(PaCO2)和血氧分压(PaO2)。结果:气腹建立后,患者于30min和60min时间点的动脉血pH较0min时间点显著降低(P【0.01);PaCO2显著上升(P【0.01)。30 min时间点pH、PaCO2与60min时间点pH、PaCO2相比则差异无统计学意义(P】0.05)。PaO2维持在较高水平,各时间点之间比较差异无统计学意义(P】0.05)。结论:中度高原地区患者行后腹腔镜手术有高碳酸血症的潜在风险,术中应予密切观察。Objective:To observe the influence of CO2 insufflation on arterial blood gas in patients in moderate altitude region,undergoing urological retroperitoneal laparoscopic operations.Methods:A total of 35 patients underwent urological retroperitoneal laparoscopic surgeries from January 2012 to October 2014.The mean age of these patients was 48years-old,including 22 males and 18 females.Pneumoretroperitoneum(12to 14 mm Hg,CO2)was established after general anesthesia.Arterial blood samples were collected for arterial blood gas analysis at three time points:0min,30 min and 60 min after insufflation.Parameters including pH,PaCO2 and PaO2 were tested.Results:Compared with 0 min,pH values at 30 min and 60 min were significantly decreased(P<0.01),and the PaCO2 values at 30 min and 60 min were greatly increased(P<0.01).There were no significant differences in both pH and PaCO between 30 min and 60min(P>0.05).During the operation,PaO2 was maintained at a high level,and no significant differences were found among three time points(P>0.05).Conclusions:Retroperitoneal carbon dioxide insufflation has a risk of hypercapnia which should be carefully detected during the surgery.

关 键 词：后腹腔镜 血气分析 二氧化碳 

分 类 号：R699[医药卫生—泌尿科学]