后腹腔镜手术CO_2气腹对脑氧供需平衡的影响

Effects of retroperitoneal carbon dioxide insufflation on the balance of cerebral oxygen metabolism

目的探讨后腹腔镜CO2气腹对脑氧供需平衡的影响。方法选择后腹腔镜下肾及肾上腺肿瘤切除术20例,ASAⅠ～Ⅱ级,分别于气腹前,气腹后10、30、60min和关气腹后30min,抽取颈静脉球血和桡动脉血进行血气分析,比较不同时点动脉血PH(aPH)、颈静脉球PH(jvPH)、动脉血二氧化碳分压(PaCO2)、动脉血糖(aGS)、动脉血乳酸(aLac)、颈内静脉血氧分压(PjvO2)、颈内静脉血氧饱和度(SjvO2)、颅内动静脉氧含量差(AjvDO2)、颈内静脉血二氧化碳分压(PjvCO2)、血糖(jvGS)和乳酸(jvLac)的变化。结果与气腹前比较,气腹后各时间点aPH、jvPH显著降低(P<0.05);PaCO2、PjvCO2气腹后各时间点与气腹前相比显著升高(P<0.05);AjvDO2气腹后各时点与气腹前相比显著下降(P<0.05);jvLac气腹后各时间点与气腹前相比有降低趋势,但无统计学差异(P>0.05);aGS、jvGS气腹前后无显著变化(P>0.05)。结论后腹腔镜手术期间,脑血流量显著增加,未发现脑无氧代谢增加的证据。

Objective To investigate the effect of retroperitoneal carbon dioxide insufflation on the balance of cerebral oxygen metabolism. Methods A total of 20 ASA Ⅰ~Ⅱ grade patients scheduled for retroperitoneal laparoscopic nephrectomy or adrenalectomy were selected. Blood samples from the bulb of jugular vein and the radial artery were taken for blood gas analysis before the carbon dioxide insufflation, at intervals of 10 min, 30 min and 60 min after the insufflation, and 30 min after the cessation of insufflation, respectively. Values of the arterial partial pressure of oxygen (PaO_2), the arterial oxygen saturation (SaO_2), the arterial partial pressure of carbon dioxide (PaCO_2), the arterial blood sugar (aGS), the arterial lactic acid (aLac), the jugular venous partial pressure of oxygen (PjvO_2), the jugular venous oxygen saturation (SjvO_2), the jugular venous partial pressure of carbon dioxide (PjvCO_2), the jugular venous blood sugar (jvGS), and the jugular venous lactic acid (jvLac) were analyzed. Results As compared with those before the insufflation, the values of PaCO_2 and PjvCO_2 after the insufflation were significantly higher (P<0.05) and the difference between arterial and jugular venous oxygen content decreased significantly (P<0.05). The values of jvLac presented a tendency of decrease after the insufflation but no significant difference as compared with the values before the insufflation (P>0.05). The values of aGS and jvGS had no significant difference after the insufflation (P>0.05). Conclusions Following retroperitoneal laparoscopy, the cerebral blood flow is increased and no cerebral anoxia is found.