硬膜外麻醉下不同二氧化碳气腹压在腹腔镜胆囊切除手术中应用的前瞻性随机对照研究

The Effects of Different CO2 Pneumoperitoneum Pressures on Laparoscopic Cholecystectomy under Epidural Anesthesia: A Prospective Randomized Controlled Trial

目的通过评价硬膜外麻醉下腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中不同二氧化碳(CO2)气腹压对患者生命体征、血气指标及术后恢复的影响,探讨LC术更经济、安全、微创的治疗条件。方法采用前瞻性随机对照研究方法,60例择期LC术分为低、中、高气腹压三组,气腹压力A组8 mm Hg,B组11 mm Hg,C组14 mm Hg。对比术前术中生命体征、血气指标及术后恢复等指标。结果60例LC术在硬膜外麻醉下均顺利完成。气腹后3组血压(BP)均明显下降(P<0.001),C组明显低于A、B组(P<0.05)。气腹后3组心率(HR)均减慢(P<0.001),3组间差异无显著性(P>0.05)。气腹后3组呼吸频率(RF)均显著增快(P<0.001),C组增加较A、B组明显(P<0.05)。气腹后3组动脉血CO2分压(PaCO2)均明显增高(P<0.05),B、C组明显高于A组(P<0.05)。气腹后3组pH值均明显降低(P<0.01),C组明显低于A组(P<0.05)。气腹后3组血浆CO2含量(TCO2)、碳酸氢根(HCO3—)明显增高(P<0.05),3组间差异无显著性(P>0.05)。3组手术时间、术中CO2消耗量、术后肩痛和恶心呕吐发生率差异无显著性(P>0.05)。结论硬膜外麻醉、低气腹压(8mm Hg)完全能够满足绝大部分LC手术需要,而且可以达到更安全、经济、微创的目的。

Objective To evaluate the effects of different CO2 pneumoperitoneum pressures on vital signs, blood gas index and postoperative recovery in patients performed by laparoscopic cholecystectomy（LC） under epidural anesthesia, so as to investigate more economic, safer and minimally invasive treatment conditions for LC. Methods Based on prospective randomize controlled trial, 60 patients scheduled for LC were divided into 3 groups： lower pressure Group A （8 mm Hg）, mediate pressure Group B （ 11 mm Hg） and higher pressure Group C （14 mm Hg）. Values of vital signs, blood gas indexes and postoperative recovery were compared among CO2 pre-insufflation and post-insufflation. Results All of 60 cases of LC were performed successfully under epidural anesthesia. Blood pressure （BP） decreased significantly after pneumoperitoneum in the 3 groups （ P 〈 0. 001 ）, and BP in the Group C was distinctively lower than that in the Group A and B （ P 〈 0.05 ）. Heart rate （HR） in the 3 groups reduced significantly after pneumoperitoneum （P 〈 0. 001 ）, but there was no significant difference among the 3 groups （P 〉 0.05）. Respiratory frequency （RF） of the 3 groups increased significantly after pneumoperitoneum （ P 〈 0. 001 ）, but the increase extent in Group C was more obvious than that in the Group A and B （ P 〈 0.05 ）. CO2 partial pressure in arterial blood （ PaCO2 ） in the 3 groups increased significantly after pneumoperitoneum （P 〈 0. 001 ）, but PaCO2 in the Group B and C was strikingly higher than that in the Group A （P 〈0.05）. pH value in the 3 groups decreased significantly after pneumoperitoneum （P 〈 0. 001 ）, but pH in the Group C was significantly lower than that in the Group A （P 〈 0.05 ）. CO2 content（ TCO2 ） and carbonic hydrogen radical （HCO3^-）in plasma of 3 groups increased significantly after pneumoperitoneum （ P 〈 O. 001 ） , but there were no obvious difference among the 3 groups （ P 〉 0.05 ）. There was no significant difference in operation time, CO2 consumption, postoperative incidence of shoulder pain, nausea and vomiting among the 3 groups （ P 〉 0.05）. Conclusions Epidural anesthesia and lower pneumoperitoneum pressure （8 mm Hg） can completely meet with demands of most LC operations, and have the advantages of safety, economy and minimal invasion.