两种不同腔镜腹股沟疝修补术CO_2充气对血流动力学与呼吸功能的影响

Effect of CO_2 on hemodynamic and respiratory function in laparoscopic inguinal hernia repair procedures: a prospective randomized controlled trial

目的:本临床研究通过比较经腹腔腹膜前腹股沟疝修补(TAPP)术和完全腹膜外腹股沟疝修补(TEP)术在不同的操作空间充入CO2气体时对病人呼吸和循环功能的影响,以论证腔镜腹股沟疝修补术的安全性。方法:将2005年1月至2005年6月,本中心将收治的腹股沟疝病人随机分成两组:20例采用经腹腔腹膜前腹股沟疝修补手术(TAPP组),20例采用完全腹膜外腹股沟疝修补手术(TEP组)。按不同的操作空间充入CO2气体,观察并比较两组手术相关指标及病理生理指标。结果:TAPP组和TEP组病人在性别、年龄、体重指数、疝类型、手术时间、住院天数、术后疼痛分数等方面,差异无统计学意义(P>0.05);TAPP组和TEP组病人术后均出现心率减慢和血压上升,呼气末CO2分压值上升,pH值下降,PaCO2和HCO3值上升,术后5min的指标与术前比较差异有统计学意义(P<0.05)。随着手术时间的延长,各指标的变化进一步加大。拔管后各指标迅速趋于恢复术前水平,但与术前指标比较,差异仍有统计学意义(P<0.05);TAPP组和TEP组的组间比较,各指标之间的差异在各个时间段均无统计学意义(P>0.05)。结论:TAPP和TEP手术均对病人的呼吸、循环产生一定影响,出现CO2蓄积、酸中毒、血压上升及心率减慢等表现。通过合理调节,可以将这些指标控制在安全的范围内,两种手术都是安全的。

Objective To investigae the effect of CO2 on hemodynamic and respiratory functions in laparoscopic inguinal hernia repair procedures, and at comparing the results of the transabdominal preperitoneal hernia repair （TAPP） with those of the totally extraperitoneal hernia repair （TEP）. The safety of the procedures was evaluated. Methods From January 2005 to June 2005, forty patients with inguinal hernia were admitted for laparoscopic inguinal hernia repair. The patients were randomly assigned to undergo the TAPP （TAPP group, n=20） or the TEP procedure （TEP group, n=20）. Hemodynamic and respiratory parameters, including the heart rate, blood pressure, end-tidal CO2 （Et CO2） and blood gas were noted and compared between the two groups. Results There was no significant difference between the two groups in terms of sex, age, ASA degree, body mass index（BMI）, type of hernia, operating time, hospital stay and postoperative pain score. In both groups, 5 minute postoperatively, the blood pressure, Et CO2, P,CO2 and HCO3 increased significantly（P〈 0.05）, and the heart rate and pH decreased significantly （P〈0.05）. All parameters recovered gradually to normal after the operations. No significant difference was found between the TAPP and TEP groups. Conclusions TAPP and TEP procedures might cause CO2 accumulation, acidosis, increased blood pressure and decreased heart rate, but their effect was transient and could be controlled by appropriate management. Both the TAPP and TEP procedures are safe for the patients.