腹腔镜结直肠切除术中PaCO2和PETCO2的变化和相关性

Changing and correlation between PaCO2 and PETCO2 during laparoscopic colorectal surgery

目的探讨腹腔镜结直肠切除术中的血流动力学与动脉血二氧化碳分压（PaCO2）和呼气末二氧化碳分压（PETCO2）的相关性。方法30例行腹腔镜结直肠切除术的患者接受气管插管全身麻醉，记录插管后5min，气腹后5min、30min、60min，建立辅助切口前和手术结束时的血流动力学指标和呼吸参数、动脉血气分析。结果本组手术时问（216．1±39．1）min，气腹时间（117．3±11．5）min。pH值随着时间的增加逐渐降低，除气腹后5min外，其余各时间点均低于插管后（P〈0．01），在手术结束时pH值略有回升。气腹后各时间点的PETCO2和PaCO2均高于插管后（P〈0．05或〈0．01），随着气腹时间的延长，PerCO2和PaCO2逐渐增加，手术结束时略有降低，但仍处于较高水平。术中PETCO2和PaCO2相关性良好，在终止气腹的一段时间内，PETCO2和PaCO2的相关性最低。结论腹腔镜结直肠切除术中，患者血流动力学波动不大，PETCO2和PaCO2相关性良好，但长时间气腹后PaCO2可能超过正常范围，术中有必要监测患者的血气分析。

Objective To investigate the changing and correlation between PaCO2 and PETCO2 during laparoscopic colorectal surgery. Methods Thirty ASA Ⅰ- Ⅱ patients scheduled for laparoscopic colorectal surgery were accepted general anesthesia and trachea cannula. Hemodynamic measurements, respiratory parametem and artery blood gas analysis were drawn at 5 rain after intubating, 5 rain, 30 rain and 60 min after pneumoperitoneum, before the side-incisions were opened and the end of operations. Results The operation time was （216.1 ± 39.1 ） min, pneumoperitoneum time was （ 117.3 ± 11.5 ） min. Comparing to the data after pneumoperitoneum, there were differences among the parameters of circulating dynamics, but the values were acceptable, pH was decreasing with time, except 5 rain ＂after pneumoperitoneum, it was significantly decreased 30 min after pneumoperitoneum until the end of operations, compared with pre-inflation value （P〈 0.01 ）, pH withdrawn a little at the end of the operations. The PETCO2 and PaCO2 at different times after pneumoperitoneum were significantly higher compared with pre-inflation value （P〈 0.05 or 〈 0.01 ）. They were increasing with the time of pneumoperitoneum, and withdrawn a little at the end of the operations. There was a good correlation between PETCO2 and PaCO2, although the correlation was worst after deflation. Conclusions The circulation dynamics are stable, the correlation of PETCO2 and PaCO2 is good during the laparoscopic colorectal surgery, PaCO2 may exceed the normal value after long-term of It is necessary to monitor the blood gas analysis during such surgeries.