妇科腹腔镜手术中气腹和非气腹对呼吸循环功能影响的比较研究

Comparison of circulatory and respiratory changes in gynecological laparoscopic surgery:between carbon dioxide pneumoperitoneum and gasless iaparoscopy

目的通过与非气腹的比较,探讨妇科腹腔镜手术中建立的CO_2气腹对患者呼吸循环功能的影响。方法依据手术方式不同,将22例ASAⅠ～Ⅱ级,无循环、呼吸系统疾病史的妇科患者分为A组:非气腹腹腔镜组(n=11),B组:气腹腹腔镜组(n=11),监测麻醉后10 min(T0)、气腹或悬腹后10 min(T1)、30 min(T2)、60 min(T3)及放气或放下腹壁后20 min(T4)五个时点的每分钟通气量、气道阻力、呼吸频率、收缩压、舒张压、平均动脉压、心率、血氧饱和度、PH值、动脉血二氧化碳分压、动脉血氧分压。结果T0时点两组各监测指标无统计学差异,T1、T2及T3时点气腹组的每分钟通气量、气道阻力、动脉血二氧化碳分压明显升高,PH值降低(P<0.05);T3时点气腹组心率明显高于非气腹组(P<0.05),T4时点气腹组的每分钟通气量仍明显高于非气腹组(P=0.00)。结论CO_2气腹对呼吸循环功能有一定影响,非气腹腹腔镜则可免除这种影响。

Objective To investigate the effects of the CO_2 pneumoperitoneum on the respiratory and circulatory function during gynecological laparoscopic surgery in direct comparison to gasless laparoscopy.Methods 22 ASAⅠ～Ⅱcases with normal circulatory and respiratory function underwent gynecological laparoscopic operation were divided into group A（the gasless group,n=11） and B（the pneumoperitoneum group,n=11） according to different modus operandi.minute ventilation（MV）,air way resistance（AWR）,respiratory rate（RR）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）, mean arterial pressure（MAP）,heart rate（HR）,pulse oxygen saturation（SPO_2）,partial pressure of carbon dioxide in artery（PaCO_2）,partial pressure of oxygen in artery（PaO_2） were measured at 10 min after anesthesia（T0）,10 min（T1）,30 min（T2）and 60 min（T3） after pneumoperitoneum（PP） or abdo minal wall was suspended,20 min after deflation or abdo minal wall was put down（T4）.Results These data were no differences between the two groups at T0.MV,AWR,PaCO_2 of the pneumoperitoneum group were higher while PH was lower significantly than those of the gasless group at T1,T2andT3（P0.05）.HR of the pneumoperitoneum group was faster at T3（P0.05）.MV of the pneumoperitoneum group was higher at T4（P=0.00）.Conclusions CO_2 pneumoperitoneum have some effects on respiratory and circulatory function,while gasless laparoscopy can avoid these effects.