过度通气对腹腔镜手术CO_2气腹前后P_(ET)CO_2及动脉血气的影响

Effects of overventilation of P_(ET) CO_2 & arterial blo od gas before and after CO_2 gas belly in laparoscopic operation

目的 研究过度通气对腹腔镜手术CO2 气腹前后的PETCO2 及动脉血气的影响。方法 选择腹腔镜手术患者 30例 ,ASAⅠ～Ⅱ级 ,男 11例 ,女 19例。给咪唑安定、硫喷妥钠、芬太尼、司可林静脉注射 ,气管内插管 ;过度通气设置 :潮气量 (VT) 10～ 12ml/kg ,频率 14～ 16次 /min ,保持PETCO2在 3 4～ 4 0kPa(2 5～ 30mmHg)。监测EKG、SpO2 、NBP、PETCO2 ;记录气管插管后 1min、气腹前、气腹后 10、2 0、30、4 0min、放气即刻、拔管前即刻的SpO2 、PETCO2 。术前、CO2气腹后 2 0min、拔管前即刻取左桡动脉血行血气分析。结果 PETCO2 在气腹前最低 ,气腹后各点均高。气腹后 2 0minPaCO2 较术前低 ,BE、SBC、ABC、TCO2 均较术前低 ,拔管前PaCO2 高于术前及气腹后 2 0min。但是术中所有参数均在正常范围。结论 过度通气可以控制腹腔镜手术CO2 气腹对PETCO2

Objective To study effects of overventilation on P ET CO 2 & arterial blood gas before and after CO 2 gas belly in laparoscopi c operation . Methods Thirty patients operated with laparoscope were sel ected,(ASAⅠ～Ⅱ,male 11, female 19). After midazolum, thiopental sodium, fentan yl and scoline were injected into vein, all the patients were taken tracheal int ubation. Overventilation was set: tidal volume 10～12 ml/kg, frequency 14～16 bpm and P ET CO 2 in 3 4～4 0 kPa(25～30 mmHg). EKG,SpO 2 ,NBP and P ET CO 2 were monitored. SpO 2 and P ET CO 2 were recorded at 1 min after t racheal intubation; before CO 2 gas belly; at 10, 20,30 and 40 min after CO 2 gas before belly; at releasing CO 2 gas; before taking out trachea l tube immediately. Left radialis arteria blood were taken for blood gas analysi s before operation, at 20 min after CO 2 gas belly before taking out tracheal t ube immediately. Results P ET CO 2 was the lowest be fore CO 2 gas belly (2 88±0 29),and on its peak 10, 20,30 and 40 min after C O 2 gas belly. PaCO 2 was lower at 20 min after CO 2 gas belly than before op eration. The BE,SBC,ABC,TCO 2 were lower at 20 min after CO 2 gas belly than b efore operation. PaCO 2 was higher before extubation than before operation and at 20 min after CO2 gas belly. All parameters were normal in the operation. Conclusion The overventilation can control effect of CO 2 gas bel ly on P ET CO 2 & arterial blood gas in laparoscopic operation.