预灌洗肾上腺素盐水对后腹腔镜手术患者二氧化碳吸收的影响

Effect of pre-lavage of adrenaline saline on absorption of carbon dioxide in patients undergoing retroperitoneal laparoscopy surgery

目的探讨后腹腔镜手术前预灌洗1：50万肾上腺素盐水对后腹腔镜手术患者二氧化碳（CO2）吸收的影响。方法选取60例择期接受后腹腔镜泌尿外科手术的患者，采用随机数字表法，将患者分为两组（n=30）：预灌洗1：50万肾上腺素盐水组（AD组）和预灌洗0．9％氯化钠注射液组（NS组）。患者于人造气腹形成后、手术开始前，AD组患者预灌洗1：50万肾上腺素盐水300ml，NS组患者预灌注0．9％氯化钠注射液300ml，3min后腹腔镜下吸引出人工气腹内的预灌洗液。分别于灌洗前（T0）、灌洗后10min（T1）、30min（T2）、60min（T3）、90min（T4）和120min（T5）时记录患者心率（HR）、平均动脉血压（MAP）、血氧饱和度（SpO2），血氧分压（PaO2）、血二氧化碳分压（PaCO2）、呼气末二氧化碳分压（PETCO2）。根据公式计算CO2排出量（VCO2）。记录患者术中心律失常及术后头痛、心悸、烦躁等不良反应发生率。结果两组患者T0时HR、MAP、SpO2、PaO2、PaCO2、PETCO2和VCO2比较差异均无统计学意义（P〉0．05）。两组患者各时间点SpO2、PaO2比较差异无统计学意义（P〉0．05）。与Ns组比较，AD组患者T1～T，时心率降低（P〈0．05），两组患者各时点MAP差异无统计学意义（P〉0．05）。与Ns组比较，AD组T1—T5时PaCO2、PETCO2和VCO2均降低（P〈0．05）。与Ns组比较，AD组患者术中心律失常及术后头痛、心悸、烦躁等不良反应发生率均降低（P〈0．05）。结论后腹腔镜手术预灌洗1：50万肾上腺素盐水能减少术中CO2的吸收，可预防术中出现高碳酸血症并能减少患者术中及术后不良反应发生率，安全且有效。

Objective To study the effect of pre - lavage of normal saline mixed with adrenaline on the absorption of car- bon dioxide （ CO2 ） in patients undergoing retroperitoneal laparoscopy surgery. Methods Sixty patients scheduled to un- dergo retroperitoneal laparoscopy surgery were divided into two groups via the random number table method ： pre - lavage of normal saline mixed with adrenaline group （ AD group, n = 30） and pre - lavage normal saline group （ NS group, n = 30）. After artificial pneumoperitoneum established and before the start of operation, patients of AD group were irrigated by 300 nil normal saline mixed with adrenaline at the concentration of 1 ： 500000, and patients of NS group were douched by the same volume of normal saline. Lavage fluid was sucked out from artificial pneumoperitoneum after 3 minutes. Heart rate （HR） ,mean arterial pressure （MAP） ,oxygen saturation（ SpO2 ） ,partial pressure of oxygen （ PaO2 ） ,partial pressure of carbon dioxide（PaCO2 ） and end tidal carbon dioxide partial pressure （PETCO2 ） were recorded before lavage （T0）, and at 10 min （T1）, 30 min （T2 ）, 60 rain （T3）, 90 min （T4） and 120 min （T5） after lavage. Carbon dioxide output （ VCO2 ） was calculated via the formula. The incidence of intraoperative arrhythmia and the incidence of postoperative complications such headache, palpitations, irritation, etc. were determined. Results There was no statistical significance （ all P 〉 0. 05 ） in HR, MAP, SpO2, PaO2, PaCO2, PETCO2 and VCO2 in each group at To. There was no sta- tistical significance （ both P 〉 0. 05） in SpO2 and PaO2 between the two groups from T1 to T5. Compared with NS group, HR of patients of AD group were lower （ P 〉 0.05 ）, while there was no statistical significance （ P 〉 0.05 ） in MAP between the two groups from T1 to T5. Compared with NS group, PaCO2 , PETCO2 and VCO2 were lower （ all P 〉 0. 05 ） from T1 to T3. Compared with NS group, the incidence of intraoperative arrhythmia and the incidence of postoperative complications such headache, palpitations, irritation, etc. were all significantly decreased （P 〉 0.05 ）. Conclusion Pre - lavage of normal saline mixed with adrenaline at the concentration of 1 ： 500000 can reduce the absorption of CO2 in patients undergoing retroperitoneal laparoscopy surgery, prevent the occurrence of hypercapnia, and decrease the incidence of intraoperative and postoperative complications.