妇科腹腔镜手术CO_2气腹时理想潮气量的探讨

Ideal tidal volume in gynecological laparoscopic surgery during pneumoperitoneum by CO_2

目的 探讨妇科腹腔镜手术CO2气腹时的理想潮气量值.方法 选择静吸复合全麻妇科腹腔镜患者30例,年龄20～50岁,体质指数（BMI）＜30 kg/m2,ASA Ⅰ ～Ⅱ级.气腹前常规麻醉行机械通气,呼吸频率为12次/min,吸呼比（I∶E）为1∶2,改变潮气量将呼气末二氧化碳分压（PetCO2）调至30～40 mmHg.气腹后逐渐调整潮气量将PetCO2调至35～45 mmHg,记录各潮气量下的脉搏血氧饱和度（SpO2）、气道峰压（Paw）、血压（BP）、PetCO2.结果 理想体重潮气量与PetCO2具有线性关系（F=35.830,P=0.000）.回归方程为：理想体重潮气量（ml/kg） =13.661-0.125×PetCO2.结论 妇科CO2气腹腹腔镜手术,固定呼吸频率为12次/min,I∶E比1∶2,单独改变潮气量可以维持有效通气,PetCO2在40 mmHg的理想体重潮气量为8.66 ml/kg,95％可信区间为8.42～8.89 ml/kg.

Objective To explore the ideal tidal volume during pneumoperitoneum in gynecological laparoscopic surgery.Methods Thirty ASA Ⅰ ～ Ⅱ patients with gynecological laparoscopic surgery were collected.Patients＇ age ranged from 20 to 50 years old and the BMI ＜ 30 kg/m2.Before pneumoperitoneum was established,general anesthesia with mechanical ventilation was given,with the basic respiratory rate of 12 times/min and I∶E of 1∶2.End-tidal partial pressure of carbon dioxide （PetCO2） was adjusted to 30～40 mmHg by changing the tidal volume alone.After pneumoperitoneum,PetCO2 was adjusted to 35～45 mmHg by changing tidal volume.The pulse oximetry saturation （SpO2）,peak airway pressure （Paw）,blood pressure （BP）,PetCO2 were recorded.Results Ideal body weight tidal volume and PetCO2 had a linear relationship （F=35.830,P=0.000）.The regression equation was ideal body weight tidal volume （ml/kg） =13.661-0.125×PetCO2.Conclusion Effective ventilation could be maintained by changing tidal volume alone during regular gynecological laparoscopic surgery.In order to keep PetCO2 at 40 mmHg when the respiratory rate is 12 times/min and I∶E is 1∶2,the ideal body weight tidal volume is 8.66 ml/kg （95％CI：8.42～8.89）.