腹腔镜与开腹肝切除术对循环呼气末二氧化碳分压及血气影响的对比研究

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

目的比较腹腔镜与开腹肝切除术对循环、呼气末二氧化碳分压(PETCO2)及血气的影响.方法2003-07～2004-07 28例肝切除患者,分为腹腔镜与开腹肝切除术2组,分别于气腹(开腹)前,气腹后30、60、120min,放气腹(关腹)后10、30 min,记录循环、PETCO2及血气.结果腹腔镜组和开腹组手术时间分别是217.8±110.5 min和175.2±67.9 min;气腹时间为207.3±102.1 min和141.1±63.2 min;术后住院天数为5.7±1.0 d和10.3±3.3 d;腹腔镜组中心静脉压(CVP)、PETCO2、二氧化碳分压(PaCO2)均明显高于开腹组(P＜0.05).结论①腹腔镜肝切除术具有手术时间长、创伤小、恢复快的特点.②对患者的呼吸、CVP、pH值等方面的影响,腹腔镜组大于开腹肝切除组.③CO2气腹导致的高碳酸血症及酸中毒,通过调整分钟通气量,给予碳酸氢钠可得到纠正.

Objective To investigate the effects of laparoscopic hepatectomy and open hepatectomy on circulation, PETCO2 and blood gas. Methods Twenty-eight patients have undergone laparoscopic hepatectomy and open hepatectomy from July 2003 - July 2004. The circulation, PETCO2 and blood gas were recorded respectively before and after pneumoperitoneum （laparotomy） 30,60,120 min, and after the deflation abdomen （close abdomen） 10,30 min. Results In the laparoscopic hepatectomy and the open hepatectomy, the operation time was 217.8 ± 110.5 min and 175.2 ± 67.9 min , respectively （ t = 1.911 , P = 0.031 ）, the pneumoperitoneum time was 207.3 ±102.1 min and 141.1±63.2 min, respectively （ t = - 2.067, P = 0.037） , and the duration of hospital stay after operation was 5.7 ± 1.0 d and 10.3 ± 3.3 d, respectively （ t=4.774 , P = 0.020） . The CVP, PETCO2, PaCO2 were significantly higher in the laparoscopic hepatectomy than in the open hepatectomy （ P 〈 0.05） . Conclusions ①The laparoscopic hepatectomy has characteristics of long operation, less harm, quick recovery.②The influence on respiration, CVP and pH were greater in the laparoscopic hepatectomy than in the open hepatectomy. ③The hypercapnia and acidosis resulted from CO2 pnettmoperitoneum, can be corrected by the regulation of respiratory minute volume and the infusion of NaHCO3.