不同气腹压力对全麻下腹腔镜胆囊切除术呼吸循环功能的影响

Effects of pneumoperitoneal pressure on respiratory function and haemodynamic in laparoscopic cholecystectomy under general anesthesia

目的观察不同气腹压力对全麻下腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC)血流动力学和呼吸功能的影响。方法60例美国麻醉医师协会(americansocietyofanesthesiologists,ASA)分级Ⅰ、Ⅱ级,因胆石症或胆囊息肉行LC的病人,随机分为高气腹压力组(H组)和低气腹压力组(L组),每组30例,两组病人全麻诱导均选择咪唑安定0.1mg/kg、芬太尼4μg/kg、异丙酚1mg/kg、维库溴铵0.1mg/kg,术中吸入异氟醚、间断静注芬太尼及维库溴铵维持麻醉。L组术中气腹压力控制在(8±1)cmH2O,H组术中气腹压力控制在(12±1)cmH2O,记录两组病人气腹前、气腹后10、20和30min和放气后5min时的BP、HR、Ppeak、PETCO2,并抽取桡动脉血行血气分析测定PaO2、PaCO2、pH、SBE,根据血气分析计算VCO2、A-aDO2、Pa-PETCO2。结果与气腹前比,气腹后两组病人的SBP、DBP均增高,HR增快,但两组间差异无显著性;两组病人的Ppeak、PETCO2、PaCO2、A-aDO2、SBE、VCO2气腹后10、20和30min均明显高于气腹前(P<0.05),且H组高于L组。结论全麻下腹腔镜胆囊切除术时采用12cmH2O腹腔CO2气腹压力会使机体CO2的吸收和排出增加,机体有呼吸性酸中毒的危险。

[Objective] To investigate the effects of different pneumoperitoneal pressure on respiratory function and haemodynamic in laparoscopic cholecystectomy under general anesthesia. [Methods] Sixty patients with cholelithiasis or gallbladder polpy, American Society of Anesthesiologists （ASA） grade Ⅰ-Ⅱ , undergoing laparoscopic cholecystectomy, were randomly allocated into one of two groups： group H and L. patients in the two groups were induced with midazolam 0.1 mg/kg, fentanyl 4 ug/kg, propofol 1 mg/kg, vecuronium 0.1 mg/kgl, anesthesia mainrained with inhaled isoflurane, intermittent intravenous fentanyl and vecuronium. Pneumoperitoneal pressure was controlled at （8±1） cmH2O in group H, and （12±1） cmH2O in group L. BP, Ppeak, PETCO2 PaO2, PaCO2, pH, SBE were observed and VCO2, A-aDO2, Pa-PETCO2 gradient were calculated before CO, instrffiation and 10, 20, 30 min after CO2 instrffiation and 5min after deflation. [Results] In the two groups, SBP and DBP were higher and HR arised after CO2 instrffiation than that before CO2 insufflation, and there was no signficant difference between the two groups. Ppeak, PETCO2, PaCO2, A-aDO2, SBE, VCO2 after insufflation were higer than that before insufflation, and higher in group H than in group L. [Conclusion] 12 cmH2O pneumoperitoneal pressure in laparoscopic cholecystectomy under general anesthesia, can increase the absorption and expiration of CO2, and has the danger of respiratory acidosis.