腹腔镜胆囊切除术气腹前后呼吸和循环的变化观察

GAS ABDOMINAL AFFECTED PULMONARY VENTILATION AND LUNG COMPLIANCE AND CIRCULATION DURING LAPAROSCOPIC CHOLECYSTECTOMY

目的：观察腹腔镜胆囊切除术患者全麻插管后气腹对肺通气、肺顺应性和循环的影响。方法：监测３０例患者气腹前、气腹后１０，２０，３０ｍｉｎ的肺顺应性（Ｃｍｐｌ）、气道峰值压力（Ｐｅａｋ）、动脉血二氧化碳分压（ＰａＣＯ２）、呼气末二氧化碳分压（ＰＥＴＣＯ２）、舒张压（ＤＢＰ）、心率（ＨＲ）、心率收缩压乘积（ＲＰＰ）的变化。结果：气腹后各时相的Ｃｍｐｌ比气腹前明显降低（Ｐ＜０．０１），ＰａＣＯ２，ＰＥＴＣＯ２和Ｐｅａｋ增比气腹前升高（Ｐ＜０．０１），气腹后ＤＢＰ升高（Ｐ＜０．０１），ＨＲ加快（Ｐ＜０．０５），ＲＰＰ值增大（Ｐ＜０．０５）。结论：气腹后肺顺应性降低，气道压力增加，肺通气受影响，体内二氧化碳蓄积；血管张力增加，心率增快，心肌氧耗增加。

Lung compliance (Cmpl),peak pressure of airway (Peak),arterial CO_2 tension (PaCO_2),final respiratory CO_2 tension (PETCO_2)and diastolic blood pressure(DBP),heart rate (HR),product of heart rate and systolic blood pressure (RPP)were observed in 30 patients before gas abdominal and 10 minutes,20 minutes and 30 minutes after gas abdominal during laparoscopic cholecystectomy.After the gas abdominal,Cmpl was reduced (P<0.01),Peak,PaCO_2 and PETCO_2 levels increased (P<0.01),and DBP,HR and RPP levels increased (P<0.05,P<0.01).Lung compliance was reduced and pulmonary ventilation was affected by the abdominal.CO_2 accumulated in the body,and blood vessel tension and the amount of oxygen consumed by the heart cells were increased.This indicates that gas abdominal could affect pulmonary ventilation and circulation.So respiration and circulation must be guarded during anesthesia period.