后腹腔镜手术对胃粘膜pH值及胃粘膜-动脉血二氧化碳分压差的影响

Effects of CO_2 insufflation on gastric intramucosal pH and PCO_2 gap during retroperitoneoscopic surgery

目的探讨后腹腔镜手术中二氧化碳(CO2)气腹对全麻患者胃粘膜pH(i-pH)和胃粘膜-动脉CO2分压差(Pg-aCO2)的影响。方法选择后腹腔镜下行肾及肾上腺手术患者20例,监测气腹前、气腹后30、60 min以及放气后30 min患者i-pH和Pg-aCO2的变化。结果气腹后动脉血CO2分压(PaCO2)较气腹前明显增加,pH值明显下降(P<0.05)。气腹后306、0 min i-pH较气腹前显著降低,而Pg-aCO2显著增加(P<0.01)。放气30 min i-pH虽较气腹期间有所回升,但与气腹前比较仍有显著性差异(P<0.05)。结论后腹腔镜CO2气腹可引起高碳酸血症和胃粘膜血流灌注降低。

Objective To investigate the effects of CO2 insufflation on gastric intramucosal pH （i-pH） and PCO2 gap gastric mucosal PCO2 minus arterial PCO2 , Pg-aCO2 during retroperitoneoscopic surgery. Methods Twenty patients, ASA Ⅰ-Ⅱ, undergoing elective retroperitoneoscopic urologic surgery were studied, i-pH and Pg-aCO2 were measured with air-automated tonometry at four time points： before retroperitoneal CO2 insufflation, at 30,60 min after CO2 insufflation, and at 30 min after exsufflation. Arterial blood gas was also analyzed at the same time points. Results Retroperitoneal insufflation resulted in a significant increase of PaCO2 and a marked decrease of arterial pH. Compared to the values before insufflation, i-pH decreased significantly at 30 and 60 min after CO2 insufflation as well as after deflating （P〈0.05 or P〈0.01 ）. Pg-aCO2 was increased markedly at 30 and 60 min after CO2 insufflation （P〈0.01）. Conclusion Retroperitoneoscopic surgery with CO2 pneumoperitoneum may result in hypercapnia and gastric intramucosal lower perfusion.