胆囊切除术中PHC对血流动力学、肺内分流和氧合的影响

Effects of PHC in LC operations on hemodynamics,intrapulmonary shunt and oxygenation

目的探讨腹腔镜胆囊切除 (LC)术中容许性高碳酸血症 (PHC)对病人血流动力学、肺内分流 (Qs/Qt)和氧合的影响。方法 2 0例ASAⅠ～Ⅱ ,无循环、呼吸系统疾病史LC术病人 ,全麻诱导插管后 ,控制呼吸潮气量为 10～ 12mL/kg ,FiO2 为 10 0 % ,吸呼比为 1∶1.5 ,调整呼吸频率至 10 ～12次 /min ,使PETCO2 在 30 ～35mmHg。行气腹手术 ,适当调节呼吸参数 ,使EtCO2 控制在 5 5 ～6 0mmHg(PHC)范围。观察病人PHC 5、15、30min血流动力学参数的变化 ,并测定动脉血气 ,计算Qs/Qt。结果PHC 5、15、30min ,MAP、CI、HR均明显升高 ,PaO2 和Qs/Qt无明显变化。结论LC术中PHC对病人血流动力学有一定影响 ,心率和心排血量均增加 ,血压升高 。

Objective To study the effects of permissive hypercapnia(PHC) in LC operations on hemodynamics, intrapulmonary shunt (Qs/Qt) and oxygenation. Methods Twenty ASAⅠ～Ⅱ patients with normal circulatory and respiratory function were included.General anaesthesia was induced with propofol 1 mg/kg,fentanyl 2 μg/kg,vecuronium 0.1 mg/kg and etomidate 0.3 mg/kg.The patients were mechanically ventilated.Tidal volume was set at 10～12 mL/kg,FiO 2=1,I∶E=1∶1.5,RR=10～12 /min and P ETCO 2 was maintained between 55～60 mmHg(PHC) after aeroperitoneum with CO 2.The data of hemodynamics and blood gas were recorded and Qs/Qt was calculated at time of BASE,before PHC,PHC 5,15,30 min. Results MAP,CI and HR increased significantly after PHC 5,15,30 min,while PaO 2 and Qs/Qt didn't change. Conclusion PHC exerts signficant effect on hemodynamics and no effect on intrapulmonary shunt and oxygenation.