妇科肿瘤腹腔镜手术CO_2气腹对呼吸与循环功能的影响

The Effects of CO_2 on Respiratroy System and Circulatory Function of Patients with Gynecological Tumor in Laparoscopic Surgery

目的研究妇科肿瘤腹腔镜手术CO2气腹对呼吸与循环功能的影响。方法选择腹腔镜手术(LO组)与开腹手术(AH组)各128例,分别于气(开)腹前(T0)、气(开)腹后10min(T1)、气(开)腹30min(T2)、气(开)腹60min(T3)和气(开)腹90min(T4)检测两组患者的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏氧饱和度(SpO2)、呼气末CO2分压(PETCO2),监测潮气量气道压(Paw)。结果LO组气腹后各时间点与气腹前比较SBP、DBP、Paw、PETCO2均有不同程度的上升,差异有统计学意义(P<0.05);AH组开腹后各时间点与开腹前比较SBP、DBP、Paw差异均无统计学意义(P>0.05),而PETCO2在手术开始后呈下降趋势,与开腹前比较差异有统计学意义(P<0.05)。两组间比较,LO组在T1,T2,T3,T4时点SBP、SDP、PAW、PETCO2均比AH组明显升高,差异有统计学意义(P<0.01)。结论气腹使患者循环动力学发生改变,通气功能下降,对合并有严重循环系统、呼吸系统并发症的患者慎用腹腔镜手术。

Objective To investigate the effects of CO2 on respiratory system and circulatory function of patients with gynecological tumor in laparoscopic surgery. Methods The 256 patients were randomly divided into two groups, laparoscopic group （LO, 128 cases）and open group （AH, 128 cases） undergoing gynecological tumor. We monitored and recorded heart rates （HR）, systolic blood pressure （SBP）, di- astolic blood pressure （DBP）, saturation pulse 02 （ SpO2）, end-tidal CO2 pressure （PETCO2） and airway pressure （Paw） at respectively before （T0）and after pneumoperitoneum （PP） （laparotomy） 10 min（T1）, 30 min（T2）, 60 min（T3）, 90 rain（T4）. Results SBP, DBP, Paw, Pc, CO2 were increased significantly after PP than those before PP in the group LO （P 〈0.05）. SBP, DBP, Paw at after open were the same as those of before open in the group AH （ P 〉 0.05 ）. PETCO2 at after open were decreased significantly than those before open in the AH group （P 〈 O. 05 ）. We compared the two groups, SBP, SDP, Paw, PET CO2 of group LO were increased significantly than those of group AH in T1 ,T2,T3 ,T4 （ P 〈 0.01 ）. Conclusion The hemodynamics changed and the ventilative function decreased during pneumoperitoneum patients. The patients with serious circulatory, respiratory complications underwent less laparoscopic surgery.