硬膜外阻滞下腹腔镜手术低气腹压对呼吸循环功能的影响

Influence of laparoscopic surgery with lower pressure of pneumoperitoneum on human respiratory and circular system under epidural block

目的观察硬膜外阻滞下腹腔镜手术患者在低气腹CO2压力下对呼吸循环参数的影响.方法监测59例患者气腹前10分钟(T1)腹内压达11～12 mmHg后15分钟(T2)、和45分钟(T3)及解除气腹后120分钟(T4),四个时点呼吸循环参数的变化,并取10例患者测动脉血气分析.术中同时记录收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SPO2),呼气末二氧化碳分压(PETCO2)、分钟通气量(VE),动脉血氧饱和度(SaO2)、动脉二氧化碳分压(PaCO2)、pH值.结果气腹后T2与气腹前HR、MAP均有上升(P＜0.05),T3、T4时段逐渐下降至T1水平.随着气腹时间的延长及辅助用药后,RR,VE,SPO2、pH值均有显著降低(P＜0.01),T3、T4时段逐渐恢复;而PETO2、PaCO2值有逐步升高的趋势(P＜0.01),T3、T4时段即开始逐渐下降恢复到初期水平.结论选择ASAⅠ～Ⅱ级患者行硬膜外阻滞能够满足腹腔镜手术的需要,低气腹压对呼吸循环功能有一定的影响,但尚在生命安全范围之内.

Objective To study the influence of pneumoperitoneum during laparoscopic surgery on human respiratory and circular system under epidural block. Methods Monitoring 59 patients' changes of respiratory and circular system at 10 minutes before pneumoperitoneum(T1),15 and 45 min after pneumoperitoneum with 11~12 mmHg pressure of abdomen(T2 and T3) and at 120 min after pneumoperitoneum(T4).Meanwhile observing arterial blood_gas analysis of 10 patients and recording SBP,DBP,MAP,HR,RR,SPO2,PETCO2,VE,SaO2,PaCO2 and Pha of all patients. Results HR and MAP increased before pneumoperitoneum and during T2 period (P<0.05) and decreased to the level of T1 during T3 and T4 periods. RR,VE,SPO2 and PH significantly decreased(P<0.001) with the times of pneumoperitoneum prolonged , some medicines used and those recovered during T3 and T4. PETCO2 and PaCO2 appeared a trend of increasing during T1 and T2, and decreased gradually during T3 and T4. Conclusion Epidural block can satisfy the needs of laparoscopic surgery on patients of ASAⅠ~Ⅱ.Lower pressure of pneumoperitoneum can influence the function of respiratory and circular system ,but it can be controlled in normal.