气腹压对妇科腹腔镜手术中呼气末七氟醚浓度的影响

Effects of pneumoperitoneum pressure on end-tidal concentration of sevoflurane in the gynecological laparoscopic surgery

目的探讨不同CO2气腹压力对妇科腹腔镜手术麻醉中呼气末七氟醚浓度(CETSev)的影响。方法 40例ASAⅠ～Ⅱ级择期行腹腔镜手术的良性妇科疾病患者随机分为两组:低压力组(10 mmHg)即LP组;高压力组(14 mmHg),即HP组,每组20例。诱导后以瑞芬太尼与七氟醚静吸复合维持麻醉,瑞芬0.2μg.kg-1.min-1恒速静脉泵注,通过调整七氟醚吸入浓度维持BIS在45～55之间。监测并记录诱导前即刻(0)、气腹前即刻(T1)、气腹后即刻(T2)、平卧位气腹后5 min(T3)、改变体位后即刻(T4)、改变体位后5 min(T5)、解除气腹前即刻(T6)、解除气腹后5 min(T7)时刻的HR、MAP、SpO2、PETCO2、及CETSev。结果两组在气腹后HR、MAP及PETCO2均明显增加(P<0.05),与LP组相比,HP组HR、MAP、PETCO2在T2～T6时刻升高明显(P<0.05)。LP组CETSev为(1.82±0.09)%,HP组CETSev为(2.11±0.08)%,两组比较有统计学意义(P<0.05)。结论妇科腹腔镜手术中不同气腹压可影响维持麻醉的七氟醚用量,低气腹压组七氟醚用量少。

Objective To investigate the effect of different CO2 pneumoperitoneum pressure on end-tidal concentration of sevoflurane in the gynecological laparoscopic surgery.Methods Forty ASAⅠ～Ⅱ patients undergoing laparoscopic operation were randomly divided into two groups（n=20）： low pressure group（10 mmHg,LP group） and high pressure group（14 mmHg,HP group）.Anesthesia was maintained with remifentanil and sevoflurane.Remifentanil was given by vein pump with constant speed 0.2 μg·kg-1·min-1,BIS was maintained between 45 to 55 by adjusting the sevoflurane inhaled concentration.HR,BP,SpO2,PETCO2,and BIS were monitored and recorded at the different time points that before induction（T0）,immediately before pneumoperitoneum（T1）,immediately after pneumoperitoneum（T2）,5 min after pneumoperitoneum with supine position（T3）,immediately trendelenbury position（T4）,5 min after trendelenbury position（T5）,immediately deflation（T6）and 5 min after deflation（T7）. Results HR,MAP and HR increased significantly in both groups after pneumoperitoneum（P0.05）,HR,MAP,PETCO2 at the T2～T6 time points in HP group increased significantly compared with those in LP group（P0.05）.CETSev was（1.82±0.09）% in the LP group,and（2.11±0.08）% in the HP group,which has a statistically significant difference（P0.05）.Conclusion Different pneumoperitoneum pressure can affect the amount of sevoflurane to maintain anesthesia in gynecologic laparoscopic surgery,and low pressure can less consumption of sevoflurane.