不同体位对腹腔镜胆囊切除术老年患者高CO_2血症的影响

Influence of Different Position on Hypercapnia in Elderly Patients Undergoing Laparoscopic Surgery for Cholelithiasis

目的：探讨降低腹腔镜下老年患者胆囊切除术血CO2浓度的最佳手术体位。方法将800例行腹腔镜胆囊切除术的老年患者随机分为试验组与对照组，每组400例。2组均按常规护理，对照组将手术床调成头高脚低位，手术床抬高30°，患者左倾15°至手术结束；试验组将手术床调成平卧位，背板抬高，患者半卧位与地面呈15°～20°至手术结束。于气腹建立前5 min（T1）及开始手术10 min（T2）、30 min（T3）、50 min（T4）、拔管后5 min（T5）监测2组患者平均动脉压（MAP）、心率（HR）、动脉血氧饱和度（SaO2）和动脉血二氧化碳分压（PaCO2）。依据国际通用的视觉模拟评分法（VAS）对患者术后24～48 h内颈肩痛及季肋部疼痛的发生情况进行评价。结果试验组T3-T5各时间点PaCO2均显著低于对照组（P＜0．05），术后颈肩及季肋部各程度疼痛发生率均显著低于对照组（P＜0．05）。结论腹腔镜手术时将背板抬高，患者半卧位与地面呈15°～20°可降低患者血中CO2浓度。

Objective To investigate the optimal surgical position for reducing blood CO2 con-centrations in elderly patients undergoing laparoscopic surgery for cholelithiasis.Methods A to-tal of 800 elderly patients with cholelithiasis were randomly divided into experimental group and control group,with 400 patients in each group.All patients received routine care.In addition,pa-tients in control group were placed in a 30°reverse Trendelenburg position with a left tilt of 15° until the end of surgery.Patients in experimental group were placed in 15°-20°semi-supine posi-tion until the end of surgery.Mean arterial pressure,heart rate,arterial oxygen saturation and car-bon dioxide partial pressure（PaCO2 ）were measured 5 minutes before pneumoperitoneum estab-lishment（T1）,10 minutes after the beginning of operation（T2）,30 minutes after the beginning of operation（T3）,50 minutes after the beginning of operation（T4）,and 5 minutes after extubation （T5）.Hypochondrium,neck and shoulder pain was assessed by visual analog scale（VAS）within 24-48 hours after operation.Results Compared with control group,PaCO2 measured at T3-T5 and postoperative incidence of hypochondrium,neck and shoulder pain significantly decreased in experimental group（P〈0.05）.Conclusion The placement in 15°-20°semi-supine position can re-duce blood CO2 concentrations in elderly patients undergoing laparoscopic surgery for cholelithia-sis.