后腹腔镜手术并发皮下气肿对患者血气和苏醒的影响

Influence of retroperitoneoscopic surgery complicated with subcutaneous emphysema on arterial blood gas and awakening time

目的探讨后腹腔镜手术并发皮下气肿对全身麻醉患者血气及苏醒的影响。方法依据皮下气肿严重程度把200例择期行后腹腔镜手术患者分为A、B、c组，其中A组为123例无皮下气肿患者；B组为54例1级和2级的轻度皮下气肿患者；c组为23例3级的重度皮下气肿患者。对B组和C组行过度通气。分别于气腹前、气腹后30、60、90min及手术结束时、拔管时、拔管后30min血气分析，同时观察苏醒情况。结果C组在T2～T4时间点的PaCO。PETCO，值均显著高于A组（P〈0．05）；C组在T2～T4时间点的pH值均显著低于A组（P〈0．05）；C组患者麻醉苏醒时间显著长于A组（P〈0．05）。C组拔管时PaCO2、拔管后30min的PaCO，显著高于A组。结论后腹腔镜手术并发重度皮下气肿导致患者高碳酸血症，苏醒时间延长。

Objective To explore the influence of retroperitoneoscopic surgery complicated with subcutaneous emphysema on results of arterial blood gas analysis and awakening time of patients under general anesthesia.Methods Two hundred patients who scheduled for retroperitoneoscopy were divided into three groups according to severity of subcutaneous emphysema:group A of 123 patients with no subcuta-neous emphysema;group B of 54 patients with mild subcutaneous emphysema of grade I or II;group C of 23 patients with severe subcutane-ous emphysema of grade Ⅲ.Patients in group B and group C were treated with excessive ventilation.At the time before pneumoperitoneum (T0)and 30 min (T1),60 min (T2),90 min (T3)after CO2 insufflation,and at the time of operation being finished (T4),tracheal extu-bation and 30 min thereafter,the arterial blood gas analysis was conducted and recorded.The awakening situation was observed at the same time point.Results At the T2~T4 time point,the PaCO2 and PETCO2 values of patients in group C were significantly higher than those in group A (P<0.05 ),but the pH values in group C were significantly lower than those in group A (P<0.05 ).The awakening time of pa-tients in group C was significantly longer than that in group A (P<0.05 ).The PaCO2 values in group C at the time of tracheal extubation and 30 min thereafter were also significantly higher than those in group A.Conclusion Retroperitoneoscopic surgery complicated with severe subcutaneous emphysema would lead to hypercapnia and delayed resuscitation in patients under general anesthesia.