腹腔镜胆囊切除术中二氧化碳气腹对心血管的影响

Effect of Carbon Dioxide Pneumoperitoneum on Cardiovascular Dynamics in Laparoscopic Cholecystectomy

目的 :观察腹腔镜胆囊切除术 (LC)中二氧化碳气腹对患者心血管的影响。方法 :选择 4 0例ASAⅠⅡ级胆囊结石或胆囊息肉择期行LC的患者 ,术前 30min肌注阿托品 0 .5mg和鲁米那钠 10 0mg ,入室后连接Dash 2 0 0 0监护仪 ,麻醉诱导用药 :咪达唑仑 30 μg/kg ,芬太尼 3μg/kg ,维库溴铵 0 .1mg/kg ,乙咪酯 0 .3mg/kg ,术中以0 .0 8% 0 .1%异丙酚维持 ,并间断吸安氟醚 ,监测并记录入室时、诱导前、插管后、气腹前、气腹后 1,3,5 ,10min的收缩压(SBP)、舒张压 (DBP)、平均动脉压 (MAP)、心率 (HR)、血氧饱和度 (SPO2 )。结果 :病人诱导前的血压、HR、SPO2 与入室时比较无明显变化 (P >0 .0 5 ) ,插管后SBP、MAP显著升高 (P <0 .0 1) ,SBP、DBP、MAP在气腹后 1、3、5、10min都显著的升高 ,与入室时比较差异有非常显著性 (P <0 .0 1) ,但升高的幅度呈下降趋势。HR在整个麻醉过程中无明显变化 (P >0 .0 5 )。SPO2 在插管后显著上升 (P <0 .0 1)。结论 :腹腔镜胆囊切除术中二氧化碳气腹对循环和呼吸虽有一定的影响 ,但在全身麻醉下加强监测和管理 ,这种影响是可以减少或避免的。

Objective:To observe the effect of carbon dioxide pneumoperitoneum on cardiovascular dynamics in laparoscopic cholecystectomy.Methods: Forty ASAⅠ~Ⅱpatients who underwent laparoscopic cholecystectomy at general anesthesia intravenously were enrolled into the study.All patients were infused atropine 0.5 mg, phenobabital sodium 100 mg before entering operation room and connected to Dash-2000 Multifunctional ECG after entering operation room .Midazolamum 30 μg/kg, Fentanylum 3 μg/kg, Norcuron 0.1 mg/kg , Etomidate 0.3 mg/kg were used in anesthesia induction.Patients were administrated with 0.08%~0.1% propofol to maintain anesthesia and inhaled enflurane interruptablly.We monitored and recorded systolic blood pressure (SBP)、diastolic blood pressure (DBP)、mean arterial pressure (MAP)、heart rates (HR) and saturation pulse O 2 (SPO 2) at 1、3、5、10 min pre-induction、post-intubation、pre-pneumoperitoneum and post-pneumoperitoneum.Results: Patients'BP、HR and SPO 2 at pre-induction were no obvious change when compared to values on entering operation room(P>0.05); SBP and MAP at post-intubation were increased significantly(P<0.01), but extent of increase seemed to decrease; HR had no change during anesthesia; SPO 2 at post-intubation increased markedly(P<0.01).Conclusion: Carbon dioxide pneumoperitoneum shows a certain effect on cardiovascular dynamics, but as long as we carefully manage and monitor the general anesthesia, the effect could be decreased or avoided.