后腹腔镜手术CO_2气腹对全身麻醉病人通气功能的影响及呼吸调控效果

Influence of Pneumoperitoneum with CO_2 on the Ventilatory Function in Patients Undergoing Retroperitoneoscopyic Surgery under General Anethesia and Effects of Respiratory Adjustment

目的探讨后腹腔镜行泌尿外科手术中CO2气腹对全身麻醉病人通气功能的影响及呼吸调控效果。方法 82例择期行后腹腔镜手术的病人依据PaCO2监测结果分为3组。A组60例,各监测时点PaCO2<8.00 kPa。其余22例采用随机数字表法分为B、C 2组,B组12例,气腹后PaCO2>8.00 kPa,呼吸频率维持12次.min-1;C组10例,气腹后PaCO2>8.00 kPa后将呼吸频率由12次.min-1调至18次.min-1。分别于气腹前(T1),气腹后30min(T2)6、0 min(T3)、90 min(T4)时抽取动脉血1 mL行血气分析,并记录pH、PaCO2等变化情况。同时观察PETCO2、Pa-PETCO2等变化情况。结果 B、C 2组气腹时间均明显长于A组(均P<0.01)。气腹后3组病人T2-T4的pH值均下降,PaCO2、PETCO2、Pa-PETCO2值均上升。与同组的T1时间点比较,B组在T2时间点PaCO2值明显升高(P<0.01),B组T4时间点PaCO2、pH、PETCO2、Pa-PETCO2与T1时间点比较差异均有统计学意义(P<0.05或P<0.01),C组PaCO2值在T2、T3时间点明显升高(P<0.05或P<0.01)。经呼吸调整后,C组全部病人PaCO2均降至正常。皮下气肿并发症:B组5例,C组2例。结论后腹腔镜手术可导致术前既已存在通气功能障碍或肥胖的病人、术中发生皮下气肿及手术时间过长的病人出现高碳酸血症,必须通过加快呼吸频率,以增加50%通气量(MV)才能排除过多的CO2。

Objective To explore the influence of pneumoperitoneum with CO2 on the ventilatory function in patients undergoing retroperitoneoscopic urologic surgery under general anethesia and to observe the effect of respiratory parameter adaption.Methods Eighty two patients scheduled for retroperitonesocopy were random number table methods divided into three groups according to the value of PaCO2.Group A：60 patients,PaCO2 was not surpassed 8.00 kPa at different time.The other 22 patients were random number table methods divided into Group B and C at random when PaCO2 was surpassed 8.00 kPa after CO2 insufflation.Group B：12 patients,PaCO2 was surpassed 8.00 kPa after CO2 insufflation and respiratory frequency was maintained at 12 times·min-1.Group C：10 patients,respiratory frequency was changed from 12 times·min-1 to 18 times·min-1 when PaCO2 was surpassed 8.00 kPa after CO2 insufflation.Before pneumoperitoneum（T1） and 30（T2）、60（T3）、90（T4）min after CO2 insufflation,the arterial blood gas was analysed and pH,PaCO2,PETCO2,Pa-PETCO2 were recorded.Results The time of insufflation in Group B and C was obviously longer than Group A（P0.01）.pH was decreased significantly at T2-T4 after CO2 insufflation in three groups.PaCO2、PETCO2、Pa-PETCO2 were increased after CO2 insufflation in all patients.PaCO2 of Group B increased noticeably at T2 compared with T1（P0.01﹚.The difference of all parameters in Group B between T4 and T1 was significant（P0.05 or P0.01﹚.PaCO2 of Group C increased at T2（P0.01﹚and T3（P0.05）.PaCO2 of Group C decreased to normal after respiratory adjustment.Subcutaneous emphysema appeared on 5 patients in Group B and 2 patients in Group C.Conclusion Retroperitoneoscopyic surgery may lead to hypercarbonemia for those patients who have respiratory disfunction or obesity or subcutaneous emphysema or overtime operation.CO2 insorbed into blood must be removed by quickening the respiratory frequency to increase 50 percent minute ventilation volume（MV）.