观察腹腔镜泌尿系手术对全麻病人血气的影响及调整通气策略的作用

An Observation on Influence of Laparoscopic Urological Surgery on Blood Gas of Patients under General Anesthesia and the Effect to Adjust Ventilation Strategies

目的：观察研究腹腔镜泌尿手术对于全麻病人的血气影响以及对其调整通气策略的作用进行分析.方法：将某院2014年-2015年进行全麻腹腔镜手术的48例患者随机等分为3组,全麻诱导持续用药时间相同,采用气管插管进行机械通气,对3组患者气腹后的通气参数进行分别测定.结果：3组患者在各个时间段的SpO2、动脉压以及心率无明显变化;患者T2时PaCO2 值持续上升;3组患者的A-aDO2在拔管后明显降低（P 〈0.05）.结论：进行CO2气腹手术可导致机体酸碱平衡失调,小潮气量的通气加低水平的呼气末正压,可有效改善肺顺应性,减少围术期的炎症发生,增强肺部通气效果,改善高碳血症或酸中毒.

Objective:To observe and research the effect of laparoscopic urological surgery on patients under general anesthesia and to analyze its effect on adjusting ventilation strategy.Methods:Randomly 48 patients underwent laparoscopic surgery under general anesthesia in some hospital during the period from 2014 to 2015into three groups in equal cases,the time of continuous medication to induct under general anesthesia were the same in the three groups,implement mechanical ventilation through tracheal intubation,and measure the parameters of the three kinds of patients related to ventilation after pneumoperitoneum.Results:There was no obvious changes in SpO2,arterial pressure and heart rate of the patients in the three groups in each period of time;When it was at T2,the value of PaCO2 keep rising continuously;A-aDO2 of the three kinds of patients reduced significantly after extubation(P<0.05).Conclusion:CO2pneumoperitoneum surgery can result in acid-base balance disorders,the combination of ventilation in low tidal volume and positive end expiratory at low levels can effectively improve pulmonary compliance,reduce perioperative inflammation,strengthen ventilation effect in lung,improve hypercapnia or acidosis.