腹腔镜肝切除术中二氧化碳气腹对循环、P_(ET)CO_2和血气值的影响及围术期麻醉处理

Influences of CO_2 pneumoperitoneum on circulation, P_(ET) CO_2 , and blood gas during laparoscopic hepatectomy

目的 探讨腹腔镜肝切除术中CO2 气腹对循环、PETCO2 和血气值的影响及术中术后的相关情况。方法 腹腔镜肝切除手术病人 14例 ,采用气管内插管全麻。分别于气腹前 ,气腹后 30min、6 0min、12 0min,放气腹后 10min、30min记录MAP、HR、CVP、PETCO2 ,气道压及血气值。观察手术时间、气腹时间、术中出血量及术后住院天数等情况。结果 各时段与气腹前相比 ,MAP、CVP无显著变化 ;HR、PETCO2 、PaCO2 、K+ 气腹后 30min明显高于气腹前 (P <0 0 5 ) ,pH值气腹后 30min明显低于气腹前 (P <0 0 5 ) ,气道压气腹后均高于气腹前 (P <0 0 5 )。结论 CO2 气腹导致的高碳酸血症及酸中毒 ,通过调整分钟通气量、给予NaHCO3 可得到纠正。

Objective To investigate the effects of CO 2 pneumoperitoneum on circulation, P ET CO 2 and blood gas during laparoscopic hepatectomy. Methods Fourteen patients underwent laparoscopic hepatectomy with CO 2 pneumoperitoneum. The MAP, HR, CVP, P ET CO 2 , airway pressure and blood gas were monitored respectively before, 30min, 60min, 120min after pneumoperitoneum, and 10min and 30min after deflation of the abdomen. Results The HR, P ET CO 2 , PaCO 2 , and plood K + were significantly higher 30min after pneumoperitoneum compared with the values before pneumoperitoneum (P<0.05). The blood pH was significantly lower 30min after pneumoperitoneum than that of before pneumoperitoneum (P<0.05). All the values pertinent to airway pressure were significantly higher after pneumoperitoneum than before it (P<0.05). Conclusions CO 2 pneumoperitoneum may produce hypercapnia and acidosis, but they can be corrected by regulation of respiratory minute volume and infusion of NaHCO 3 .