腹腔镜手术中手术方式和体位对患者呼吸循环的影响

Effect and nursing of laparoscopic operation and position on respiratory and circulatory function of patient during laparoscopic operation

目的探讨三种不同腹腔镜手术方式和体位对患者呼吸循环的影响。方法气管内麻醉下行择期腹腔镜胆囊切除术(A组)、腹腔镜子宫肌瘤剔除术(B组)、腹腔镜肾囊肿去顶术(C组),各15例,ASAⅠ-Ⅱ级,术前心肺功能正常。A组仰卧位头高足低,B组仰卧位头低足高,C组侧卧位。暴露肾区,CO2气腹压力维持在13～15mmHg,连续监测心率(HR)、平均动脉压(MAP)、呼吸末二氧化碳(PETCO2)及气道峰压(Ppeak)。分别于安置体位后气腹前5min(T0)、气腹后10min(T1)、30min(T2)及气腹结束后体位不变5min(T3),记录各测量值。结果三组各时间点HR、MAP组间比较无显著性差异(P>0.05),B组及C组的MAP在T1、T2、T3时较T0时明显升高(P<0.05)。B组在T1、T2时间点的Ppeak、PETCO2高于A组及C组,组内比较B组在T1、T2时的Ppeak值较T0时升高(P<0.05);三组T1、T2时的PETCO2均较T0时明显升高(P<0.05)。结论三种腹腔镜手术方式和体位对心率的影响相似,下腹部及腹膜后手术对血压影响程度大于上腹部手术,同时头低足高位对呼吸功能的影响最大。

Objective To study the effect and nursing of three aparoscopic operation and position on respiratory and circulatory function of patients. Methods ASA Ⅰ-- Ⅱ patients undergoing laparoscopic cholecystectomy（A group）, laparoscopic myomectmy （B group ） and laparoscopic renal cystectomy（C group） were selected and divided into three groups with 15 patients respectively, all patients use endotracheal anesthesia during operation, and the heart and lung functions are nomal. A group is dorsal position of Reverse-trendelenburge. B group is dorsal position of trendelenburg. C group is lateral position to expose renal region. Pneumoperitoneum pressure set at 13- 15mmHg. HR, MAP, PETCO2, Ppeak were recorded 5 min before pneumoperitoneum, 10, 30 min after pneumoperitoneum and 5 min after deflation respectively. Results The HR, MAP of three group patients at different time points were not significant （P〉0. 05）. The Ppeak and PETCO2 of B group at T1 and T2 time points were significantly higher than A and C groups, but there was no significance between A group and C group. In B group, the Ppeak of T1 and T2 were significantly higher than T0 （P〈0. 05）. And the PETCO2 of T1 and T2 were all significantly higher than To （P〈0. 05）in each groups. Conclusion The effect of three laparoscopic operation and position on HR are similar. Operations on hypogastrium and retroperitoneurn had larger influence in HP than epigastrium. Operations on hypogastrium had the largest influence in respiratory function.