不同全麻诱导方法对腹腔镜胆囊切除患者胃胀程度和血气的影响

Effects of different general anesthesia induction methods on gastric distension and blood gas in patients under laparoscopic cholecystectomy

目的:研究手控正压通气和自主呼吸两种全麻诱导对腹腔镜胆囊切除术(LC)患者胃膨胀程度和血气值的影响。方法:随机将30例择期LC患者分为手控正压通气组(P组)和自主呼吸组(S组)。结果:两组诱导前各血气参数无显著差异。诱导后,S组pH下降、PaCO2升高(P<0.05 vs.基础值)。P组诱导前后血气值无显著变化(P>0.05),两组诱导后PaO2值均显著高于诱导前(P<0.05)。P组又高于S组(P<0.05)。S组胃胀气评分值显著小于P组(P<0.05)。结论:不预置胃管时,手控正压诱导不影响血气值,但增加胃胀气程度,对术中显露有一定的影响。自主呼吸诱导不增加胃胀气,不增加术中显露难度,可用于普通患者,但可引起短暂呼吸性酸中毒,不宜用于术前有CO2蓄积类疾病的患者。

Objective：To investigate the effects of two different general anesthesia induction methods manual positive ventilation and spontaneous ventilation on gastric distension and bolld gas values in patients with laparoscopic cholecystectomy（LC）. Methods ：Thirty patients were randomly and evenly divided into manual positive ventilation group（ group P）and spontaneous ventilation group （ group S）. Results： After induction, pH decreased and PaCO2 increased in groups S （ P 〈 0.05 vs. baseline）, but they had no significant changes in group P（P 〉 0.05 vs. baseline）. PaO2 value in both groups after induction increased markedly （ P 〈 0.05 vs. corresponding baselines）, with the value in group P being even higher than that group S （ P 〈 0.05 ）. Gastric distension score in group S were significantly lower than that in group P（P 〈 0.05）. Conclusions：In LC patients without stomach tubes, manual positive ventilation has no effect on pH and PaCO2 ,but it will lead to gastric distension, which may hinder surgical exposures during LC operation. On the other hand, spontaneous ventilated induction has no effect on gastric distension, which will favor the surgical exposures and can be routinely applied to ordinary LC patients, However,it will cause temporary respiratory acidosis and can not be applied in patients with diseases of increased PaCO2,such as COPD.