两种腹腔镜胆囊切除术术式对机体血气参数及PET CO_2的影响

The influence of pneumoperitoneum and suspensory on blood-gas parameters and end-tidal pressure of carbon dioxide during laparoscopic cholecystectomy

目的观察对比气腹腹腔镜与悬吊腹腔镜胆囊切除术对心肺功能正常患者血气分析及呼吸末CO2分压(PET CO2)的影响。方法选择60例心电图、胸部正位片正常的患者,均在全身麻醉下行腹腔镜胆囊切除术,按术式分为气腹组和悬吊组,每组30例。分别于麻醉后5 min(T1)、术中气腹或悬吊后20 min(T2)、术后停气腹或悬吊后30 min(T3)抽取患者足背动脉血行血气分析,记录各个时段动脉血pH值、PaCO2、CO2总量以及T1、T2时段的PET CO2。结果两组术前及术后各项指标差异无统计学意义(P>0.05),术中两组间各项指标差异有统计学意义(P<0.05)。气腹组术前、术中各项指标及术中、术后各项指标比较差异有统计学意义(P<0.05),术前、术后比较仅pH值差异有统计学意义(P<0.05)。悬吊组术前、术中、术后各项指标两两比较差异无统计学意义(P>0.05)。结论气腹腹腔镜手术对机体血气的影响大于悬吊腹腔镜手术,合并心肺功能障碍、老年患者、预计手术时间长的患者,提倡选择悬吊腹腔镜手术。

Objective To observe and compare the influence of pneumoperitoneum and suspensory on blood-gas parameters and end-tidal carbon dioxide pressure during laparoscopic cholecystectomy in patients with normal heart and lung function.Methods Selected 60 patients with normal electrocardiogram and l chest anteroposterior films,all of them were under general anesthesia during laparoscopic cholecystectomy.They were separated equally by different laparoscopic techniques into pneumoperitoneum laparoscopic cholecystectomy（PLC）and suspensory laparoscopic cholecystectomy（SLC）.The two group were assayed their blood-gas parameters of dorsalis pedis artery when 5 minutes after anesthesia but before surgery（T1）,20 minutes after pneumoperitoneum or suspensory during surgery（T2）,30 minutes after pneumoperitoneum or suspensory termination（T3）,recorded the pH value,arterial partial pressure of carbon dioxide（PaCO2）,the amount of carbon dioxide of all the blood samples were taken at different time points,and record the value of end-tidal pressure of carbon dioxide（PET CO2） of T1 and T2 periods.Results Every outcomes of the two groups had no significant difference between preoperative and postoperative（P 0.05）,however,they had statistical differences intraoperative（P 0.05）.Preoperative,intraoperative and postoperative pairwise comparison of the PLC group had significantly difference（P 0.05）,but PaCO2 and the amount of carbon dioxide had no statistical difference（P 0.05）.Preoperative,intraoperative and postoperative pairwise comparison of the SLC group had no significant differences（P 0.05）.Conclusions The impact to blood-gas parameters of the PLC group during laparoscopic is much more than the SLC group.Patients who with cardiopulmonary dysfunction,aged and expected procedure of surgery are advised to select SLC.