腹腔镜手术二氧化碳气腹充气过程中腹内压改变对呼吸力学的影响

Effcet of Intro-abdormial Pressure on Respiratory Dynamics During Laparoscopic Operation

为进一步了解ＣＯ２气腹充气时对呼吸力学的影响，对３０例腹腔镜下行胆囊切除术的患者观察了腹内压达０．５、１．１、１．６～１．９ｋＰａ及气腹５ｍｉｎ、１０ｍｉｎ时的呼吸力学参数的变化。结果表明：呼吸力学的改变与腹内压增加相关显著（Ｐ＜０．０１）。潮气量（ＴＶ）、分钟通气量（ＭＶ）、胸肺顺应性（Ｃ）随着腹内压的增高而明显降低，下降最低值分别较气腹前低１４％、１８％和５１％。气道峰压（Ｐｐｅａｋ）、气道坪压（Ｐｐｌａｔ）和一秒率（Ｖ１．Ｏ％）则随腹内压的增高而上升，最高值分别较气腹前高３０％、４３％、和１３％，Ｐｅｔ－ＣＯ２呈先降后升的变化，可能与腹内压骤升引起Ｖ／Ｑ比值失调有关。根据上述结果认为，二氧化碳充气过程中腹内压的改变对呼吸力学有显著影响，即使在全麻下也是如此。适当减缓充气速度，可能有助于减轻气腹对呼吸功能的剧烈影响。

ffect of different intro-abdomind pressure(IAP)on respiratory dynamics was studied in 30 patients undergo-ing laparoscopic cholecystectomy(LC).Respiratory dynamic parameters at 0.5,1.1,1.6～1. 9kPa after 5 and 10minutes of peritoneal insufflation(PI) with CO2 were recorded. The results show that TV,MV and EC decreasedsignificantly with the increase of IAP. The lowest values were 14%,18%and 5l%lower than those before PI.Ppeak Pplat and FEV1. 0 increased in correspondence with IAP , up to 30%,40%and 13%of those before PI.Pet-CO2 increased gradually after a short term of decrease,This may be due to the change of V/Q ratio caused by sharprising of IAP. Based on these results,we conclude that even under generel anesthesia,changs of IAP during PImay greatly affect respiretory dynamics.