妇科腹腔镜手术不同气腹压及不同气腹时段的临床观察

Clinical observation of different intra-abdominal pressure and different time points during gynecological laparo- scopic operations

目的观察妇科腹腔镜手术在不同气腹压及气腹不同时段对血流动力学、呼气末二氧化碳分压和气道压的影响。方法选择60例ASAⅠ级行妇科腹腔镜手术患者.随机分为两组,分别为气腹压1.3 kPa和1.9 kPa,监测并记录麻醉前(T_0),插管后即刻(T_1).气腹前(T_2),气腹平卧后5 min(T_3),气腹特定体位后5 min(T_4)、10 min(T_5)、20 min(T_6)、30 min(T_7),术毕放气后5 min(T_8)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、ST段值、气道压(Paw)、呼气末二氧化碳分压(P_(ET)CO_2)。结果两组患者气腹后T_3、T_4、T_5时段SBP、DBP、MAP与T_0时段相比显著升高(P<0.01),但升高的幅度呈下降趋势,T_6时段开始血压下降至术毕。HR在整个气腹期间与T_0相比下降显著(P<0.01)。ST段值在上述期间则向上抬高(P<0.01),而上述指征对应时段两组间差异无统计学意义(P>0.05),但Paw和P_(ET)CO_2组间、组内气腹前后差异均有统计学意义(P<0.05)。结论妇科腹腔镜手术在气腹压(IAP)为1.3 kPa和1.9 kPa时对血流动力学的影响无明显差异,但对呼气末二氧化碳分压和气道压的影响差异有统计学意义。

Objective To observe the effect of different intra-abdominal pressure and different time points on hemodynamies, ent-tidal CO2 （ PETCO2 ） and airway pressure（Paw） during the procedure of gynecological laparoscopic operations. Methods 60 cases undergoing gynecological laparoscopic operations were randomly divided into two groups：the intra-abdominal pressure was 1.3kPa in group Ⅰ （30 cases） and 1.9kPa in group Ⅱ （30 cases）. ASA Ⅰ grade. In both groups, systolic blood pressure（SBP）, diastolic blood pressure （DBP）, mean arterial pressure （MAP）, heart rates（HR）, S-T, Paw and PETCO2 were monitored and recorded before anesthesia（ T0 ）,shortly after intubation （T1）, pre-pneumoperitoneum （ T2 ） , 5min after pneumoperitoneum （ supine position） （ T3 ） and 5min （ T4 ） , 10min （T5 ） ,20min（T6 ）, 30min（ T7 ） after trendelenbury position （ head down 200 ） and 5min after deflation （ T8 ）. Results In both groups SBP,DBP,MAP at time point T3, T4, T5 were increased significantly compared with those of To （ P 〈 0.01）. But. the extent of increase seemed to decrease sequencely, the blood pressure decreased from T6 to deflation. Compared with that of TO, HR was decreased and S-T increased significantly（ P〈 0.01） in all the time points during pneumoperitoneum. There was no significant differences in hemodynamies between the two groups in the same time point（ P 〉 0.05）, but there was significant difference in Paw and PETCO2 in different time points within the same group and between the same time point in different groups after pneumoperitoneum（ P 〈 0.01 ）. Conclusion There is no significant hemodynamic differences between intra-abdominal pressure 1.3kPa and 1.9kPa during gynecological laparoscopic operation,which results in significant difference in Paw and PETCO2.