后腹腔镜和腹腔镜手术二氧化碳气腹对患者二氧化碳吸收的影响

Effects of retroperitoneal and transperitoneal endoscopic surgery on carbon dioxide absorption during pneumoperitoneum

目的比较后腹腔镜和腹腔镜手术CO2气腹对患者CO2吸收的影响。方法择期泌尿外科行后腹腔镜手术(R组)以及普外科和妇产科行腹腔镜手术(T组)患者各20例,分别于全麻机械通气后气腹前(T0)、气腹后30min(T1)、60min(T2)、90min(T3)和放气后10min(T4)、清醒气管导管拔除(T5)记录MAP、HR、PETCO2、气道峰压(Ppeak),并行血气分析,计算CO2排出量(VCO2)、动脉血-呼气末CO2差值(PaCO2-PETCO2)。结果两组气腹后各时点Ppeak、PaCO2、PETCO2、PaCO2-PETCO2和VCO2均较气腹前显著增高,并随着气腹时间的延长而持续缓慢增高(P<0.01)。与T组比较,R组气腹后PETCO2、PaCO2、VCO2的增加更加明显。结论与腹腔镜手术相比,后腹腔镜手术气腹期间CO2吸收更显著;PETCO2和血气监测在后腹腔镜手术应列为常规。

Objec-live To compare the effects of retroperitoneal（RP） and transperitoneal（TP） endoscopic surgery on carbon dioxide （CO2） absorption during pneumoperitoneum Methods Forty patients undergoing endoscopic surgery under general anesthesia were divided into two groups with 20 cases each. The patients in group R received retroperitoneal endoscopic surgery and those in group T received transperitoneal endoscopic surgery under CO2 pneumoperitoneum during surgery. MAP, HR, Ppeak, PETCO2 and PaCO2 were recorded, PaCO2 PET-CO2 and VCO2 were calculated at six time points of before insufflation（T0）, CO2 insufflation for 30 min（T1 ）, 60 min（T2 ）, 90 min（T3 ）, after CO2 deflating for 10 min（T4 ） and after tracheal extubation（T5）. Results Compared to before, Ppeak, PaCO2, PETCO2, PaCO2-PETCO2 and VCO2. were increased in a time-dependent manner during CO2 pneumoperitoneum in both groups （P 〈 0.01 ）. PaCO2, PETCO2, VCO2 were higher in group R than those in group T（P〈0.05）. Conclusion Compared to TP endoscopic surgery,RP endoscopic surgery results more CO2 absorption and artery blood gas analysis is needed during endoscopic surgery.