腹腔镜肝脏切除手术的麻醉处理

Anesthetic management of laparoscopic hepatectomy

目的总结腹腔镜肝脏切除手术麻醉的方法和经验,探讨术中CO2气腹对呼气末二氧化碳分压(PETCO2)、气道压、血气值的影响以及术中的麻醉管理方法。方法 10例择期行腹腔镜肝脏切除手术的患者采用静脉复合全身麻醉,记录气腹前(T0),气腹后30min(T1),放气腹后30min(T2)的PETCO2、气道压和血气值并观察手术时间、气腹时间、术中出血量等情况。结果与T0比较,T1时刻的PETCO2、动脉血二氧化碳分压(PaCO2)、K+与气道压明显升高(P<0.05)、pH值明显降低(P<0.05)。结论腹腔镜肝脏切除手术围麻醉期应注意CO2气腹对循环和呼吸的影响,加强容量和呼吸的调控管理,保持血流动力学稳定和内环境的平衡。

Objective To summarize the anesthetic managements of laparoscopic hepatectomy, and investigate the effects of CO2 pneumoperitoneum on PETCO2, airway pressure and blood gas during laparoscopic hepatectomy. Methods Ten patients underwent laparoscopic hepatectomy with CO2 pneumoperitoneum. The PETCO2, airway pressure and blood gas was monitored at the time points before CO2 pneumoperitoneum（T0）, 30rains after pneumoperitoneum（T1） and 30 rain after deflation of the abdomen（T2）. Results At T], the PETCO2, PaCO2, K＋ and airway pressure in- creased significantly compared to TO （P〈0. 05）, and the pH decreased significantly compared to TO （P〈0. 05）. Conclusion The effects of CO2 pneumoperitoneum should be prevented by a perfect anesthetic managements.