后腹膜腔镜泌尿系手术全麻对呼吸循环功能的影响及通气策略探讨

The Influence of Retroperitoneal Laparoscopic Operation on Respiratory and Circulatory System

目的:观察全麻时后腹膜腔镜泌尿系手术CO_2气腹对呼吸循环功能的影响及调整通气方式的作用。方法:36例患者分为3组,每组12例,麻醉后控制呼吸,VT 8 mL/kg,RR 10 bpm。Ⅱ组患者于手术开始时改变呼吸参数:VT10 mL/kg,RR 12 bpm,Ⅲ组VT 10 mL/kg,RR 14bpm,Ⅰ组则保持呼吸参数不变。于麻醉前、CO_2气腹前、气腹后10、30、45、60 min记录BP、HR、SpO_2、P_(ET)CO_2、PaCO_2和pH。结果:与充气前比较BP、HR 3组均升高(P<0.05),但组间比较差异无统计学意义(P>0.05)。P_(ET)CO_2Ⅰ、Ⅱ组充分后各时点与麻醉前相比持续升高(P<0.05～0.01),45～60 min达高峰。Ⅲ组于30min内升高不明显(P>0.05),但其后逐渐升高(P<0.05)。组间比较,Ⅰ组上升幅度最大,Ⅱ组次之,Ⅲ组在30 min后才有明显上升,而且上升幅度低于Ⅰ、Ⅱ组(P<0.05),但Ⅰ、Ⅱ组间差异无统计学意义(P>0.05);pH、PaCO_2呈现相似的变化。结论:通气增加潮气量和呼吸频率的过度通气方式,可以在一定程度上减轻CO_2吸收导致的高碳酸血症或酸中毒,Ⅲ组的通气方式效果更明显。

Objective： To evaluate the influence of retroperitoneal laparoscopic surgery on respiratory and circulatory function and ventilation mode. Methods： 36 patients were divided into three groups, the ventilation was 10ml/kg,the respiration rate was 12 bpm. In group Ⅱ , the respiratory parameters was VT10mL/kg and RR12bpm; in group Ⅲ , the respiratory parameters was VT10mL/kg and RR14bpm; The BP, HR, SpO2, PETCO2, PaCO2 and pH of the patient were monitored. Results： BP and HR of the patient increased after insufflation（ P 〈 0.05） , no significant difference was found between each gruup（P 〉0.05）. PETCO2 in group Ⅰ and Ⅱ increased significantly after anesthesia and reached peak value in 45 -60 minutes. A significant increase was found in In group Ⅰ , so was group Ⅲ , a increase was found in group m after 30 minutes. Conclusion： High tidal volume ventilation and respiration rate are effective for the alleviation of hypercapnia and acidosis.