腹腔镜手术期间二氧化碳气腹对脑氧供的影响

Effects of carbon dioxide insufflation on cerebral oxygen delivery during laparoscopic operation

目的：观察腹腔镜手术期间病人脑氧饱和度（ｒＳＯ２）、脉搏血氧饱和度（ＳｐＯ２）及动脉血二氧化碳分压（ＰａＣＯ２）、ｐＨ值和ＨＣＯ－３浓度等指标的变化，以了解二氧化碳气腹对病人脑氧供的影响。方法：选择行腹腔镜胆囊切除术病人１５例，于气腹前、气腹后２０分钟及术毕３０分钟检测ｒＳＯ２、ＳｐＯ２、ＰａＣＯ２、ｐＨ值和ＨＣＯ－３。结果：气腹后２０分钟ｒＳＯ２和ＰａＣＯ２增高（Ｐ＜０．０１或Ｐ＜０．０５），ｐＨ值降低（Ｐ＜０．０１），ＨＣＯ－３变化不明显。术毕３０分钟ｒＳＯ２、ＰａＣＯ２和ｐＨ值恢复至术前水平，ＳｐＯ２变化无临床意义。ＰａＣＯ２与ｒＳＯ２在气腹期间呈显著正相关（ｒ＝０．７８，Ｐ＜０．０１）。结论：在腹腔镜手术期间，二氧化碳气腹不会对脑氧供产生不良影响。

Objective:In order to demonstrate the effects of carbon dioxide insufflation on cerebral oxygen delivery.Method:Fifteen patients under laparoscopic cholecystectomy were selected.The changes of regional cerebral oxygen saturation(rSO 2),pulse oxygen saturation (SpO 2),arterial partial pressure of carbon dioxde(PaCO 2),acid base scale(pH)and concentration of bicarbonate(HCO - 3)were observed before insufflation,20 min after insufflation and 30 min after operation.Result:rSO 2 and PaCO 2 were increased significantly(P<0 01 or P<0 05) and pH decreased significantly(P<0 01) at 20 min after the peritoneal insufflation.The change of HCO - 3 was not significant during laparoscopic cholecystectomy,At 30th min after operation,rSO 2,PaCO 2 and pH recovered.The correlation between PaCO 2 and rSO 2 was significantly positive(r=0.78,P<0.01) Conclusion:Cerebral oxygen delivery cannot be influenced by carbon dioxide insufflation during laproscopic operation.