肺肿瘤与贲门食道下段肿瘤切除术中病人PaCO_2-P_(ET)CO_2差值临床观察

The Variations of PaCO_2-P_(ET)CO_2 in the Patients of Pneumonectomy and Esophagectomy

为了了解开胸手术中PaCO_2-P_(ET)CO_2差值的变化及影响因素,观察了43例胸科手术病人,其中肺肿瘤23例、食道贲门肿瘤20例,全部为ASAⅠ～Ⅲ级患者。常规静脉诱导,吸入异氟烷维持麻醉。术中间断给予芬太尼、卡肌宁。分别于麻醉及术中的5个时间点抽取动脉血测定PaCO_2,同时测定P_(ET)CO_2及HR、BP等。结果发现:1.43例开胸前其PaCO_2-P_(ET)CO_2均值都在0.3～0.8kPa之间。2.开胸后10min食道手术患者PaCO_2-P_(ET)CO_2升高有非常显著意义(P<0.01),其余各相邻值间差别无显著性(P>0.05)。3.肺肿瘤患者术中PaCO_2-P_(ET)CO_2在开胸后1小时其PaCO_2-P_(ET)CO_2非常显著升高(P<0.01),其余各相邻值间未见明显变化(P>0.05)。结果表明:开胸手术中,在血压、心率、体位及胸腔负压变化、通气等条件相对稳定时,手术操作刺激对肺通气、血流及其比值(V/Q),并进而对PaCO_2-P_(ET)CO_2产生明显影响。经过一段时间肺组织可逐步适应这种刺激而建立新的平衡,从而PaCO_2-P_(ET)CO_2未发生进一步明显变化。

For exploring the variations of PaCO2-PETCO2 during chest operation, 43 patients were studied. Among them there were 23 pneumonectomy and 20 esophagectomy. During anesthesia and operation , blood from radial artery was drawn in five different times for gas analysis. And in the meantime , PaCO2-PETCO2, blood pressure and heart rate were determined. The conclusion results were (1) in all of the 43 patients the mean values of PaCO2-PETCO2 were between 0. 3-0. 8kPa; (2)after opening chest for about 10 minutes there was a significant rising in the value of PaCO2-PETCO2 (P< 0. 01)in esophagectomy patients; (3)after opening chest about 1 hour,there was a great increase in PaCO2-PETCO2(P<0. 01)in pneumonectomy patients. According to the above results,it was concluded that when the BP,HR and tidal volume were unchanged,stimulus by operation was the main factor affecting PaCO2-PETCO2,and the body could be suited to this stimulus gradually,then PaCO2-PETCO2 was not changed further.