高原地区腹腔镜手术中CO_2气腹对循环功能的影响

Impact of CO_2 Aeroperitoneum during Laparoscopic Operation on Circulatory Function at Plateau.

目的观察高海拔(>3 000 m,PO2<75%)地区腹腔镜手术CO2气腹对循环功能影响,为高海拔地区安全施行腹腔镜手术提供依据。方法高原择期行腹腔镜腹部手术患者80例,随机分为A组40例;B组40例。气腹A组用硝酸甘油、硫酸镁、美托洛尔控制血压和心率;B组不予控制,观察气腹期间血流动力学的变化。结果B组的收缩压(SBP)、舒张压(DBP)、心率(HR)、心肌氧耗指数(RPP)与麻醉前相比气腹5 m in时开始显著升高,并且持续到30,60 m in无统计学差异;A组气腹5、10 m in时DBP稍高,RPP气腹开始30 m in内显著升高;B组SBP、DBP、RPP在30m in内高于A组(P<0.05)。结论CO2气腹初期可引起循环功能的显著变化,气腹60 m in恢复到麻醉前水平,适当控制心率和血压可降低RPP,有利于保护心肌。

Objective To study the impact of CO2 aeroperitoneum during laparoscopic operation on circulatory function and to provide clinical proof for safe laparoscopic operation at high altitude area（〉3000 meter,PO2〈75 percent）.Methods 80 patients randomly selected for laparoscopic operation on abdominal region at high altitude area,were divided into A group（n=40） and B group（n=40）.Blood pressure and heart rate were controlled with nitrolar,epsom salt and metoprolol in A group and none was in B group.hemodynamic change during aeroperitoneum was observed.Results Compared with those before anaesthesia,diastolic blood pressure（DBP）,heart rate（HR） and rate-pressure product（RPP） of B group began to remarkably heighten after 5 minutes of aeroperitoneum and continued to 30 minutes of aeroperitoneum.There was no diference at 60 minutes of aeroperitoneum.DBP of A group was higher at 5 and 10 minutes of aeroperitoneum.RPP of A group remarkably heighten during initia 30 minutes of aeroperitoneum.SBP,DBP and RPP of B group were higher than those of A group during 30 minutes of aeroperitoneum（P〈0.05）.Conclusion CO2 aeroperitoneum can cause significant change of circulatory function in the initial stage.Circulatory function recover to the level before anaesthesia after 60 minutes of aeroperitoneum.Appropriately control blood pressure and heart rate can lower RPP and were in favour of protecting the cardiac muscle.