腹腔镜胆总管切开取石T管引流术围手术期呼吸力学参数变化观察

Observation on perioperative breath mechanics parameter change of the LCTD technique

目的总结腹腔镜胆总管切开取石T管引流术（LCTD）患者围手术期呼吸力学参数变化。方法对30例LCTD患者围手术期pH值、CO2排出量（VCO2）、CO2分压（PaCO2）、呼气末CO2分压（PetCO2）、气道压（PAW）及血氧饱和度（SPO2）的变化进行统计。记录的5个时间点包括麻醉后T0（气腹前），T1（气腹后15min左右，气腹基本平稳，达到打孔要求），T2（气腹后30min左右，各戳孔套管放置成功，体位改为头高足低位后），T，（手术中，手术进行约60min左右），Td（放气后10min左右）。结果pH值在气腹开始后逐渐降低，30min（T2）时较诱导前显著降低；VCO2、PaCO2、PetCO2、PAW于气腹后15min开始增高明显（P〈0．05），并随手术时间的延长而继续缓慢增高；气腹后SPO2有降低趋势，手术结束放气后恢复到正常状态，但其变化差异无统计学意义（P〉0．05）。结论LCTD围手术期必须对其呼吸系统相关指标进行严密检测，及时发现异常变化并早期处理，以减少并发症的发生。

Objective To sum up changes in perioperative breath mechanics parameter during LCTD. Method Perioperative related indexes in 30 cases of LCTD, including pH values, CO2 displacement （VCO2 ）, the CO2 differential pressure （PaCO2 ）, at the end of the expiration CO2 differential pressure （ PetCO2 ）, the gas channel presses （PAW） and the blood oxygen degree of saturation （ SPO2 ） the change carries on the statistics. The recording four time spot includes ： After the anaesthesia To （ pre - pneumoperitoneum）, Tt （pneumoperitoneum about 15 min, pneumoperitoneum is steady, after achieved drills a hole request）,T2 （approximately pneumoperitoneum about 30 min,various stamps hole drive pipe lays aside successfully, after body posture changes a high full low position） and T3 （in surgery, after surgery carries on approximately about 60 min）, T4 （deflates about 10 min）. Result The pH value after pneumoperitoneum starts,gradually reduces, 30 min （T2 ） before when comparatively induces remarkably reduees;VCO2,PaCO2,PetCO2, PAW after pneumoperitoneum 15 min start to advance obviously （P 〈 0.05 ）, and lengthens along with the surgery time continues slowly to advance; After the SPO2 pneumoperitoneum blood oxygen degree of saturation has reduces the tendency, after the surgery ended deflates restores to the normal state, but it changes the non - statistics difference （ P 〉 0.05 ）. Conclusion The LCTD technique encircles the surgery time to have to carry on the strict examination to its respiratory system index of correlation ,the prompt discovery exceptionally changes and early processing, reduces the illness complication the occurrence.