不同体位对腹腔镜下子宫内膜异位症手术患者动脉血气指标的影响

Effects of different body positions on arterial blood gas indexes of patients undergoing laparoscopic endometriosis surgery

目的分析不同体位对腹腔镜下子宫内膜异位症手术患者动脉血气指标的影响。方法选择2018年2月至2020年5月行腹腔镜手术治疗的子宫内膜异位症患者94例,采用随机数字表法分为A组和B组,每组47例。2组患者采用相同方法进行麻醉诱导,气腹完成后2组患者均取头低脚高位,A组将摇床后倾30°,B组将摇床后倾20°,开始手术。比较2组患者手术一般情况、动脉血气分析指标、血流动力学参数、眼内压及并发症发生情况。结果2组患者手术时间、苏醒时间、丙泊酚用量、瑞芬太尼用量差异均无统计学意义(P>0.05)。2组患者体位改变30 min后pH值及血氧分压均较气腹前明显下降,但A组下降幅度更大,2组患者体位改变30 min后CO_(2)分压均较气腹前明显升高,但A组升高更明显(P<0.05)。体位改变30 min后2组患者平均动脉压均明显下降,但B组下降幅度更大;体位改变30 min后2组患者心率均明显升高,但B组升高更明显;体位改变30 min后2组患者眼内压均明显升高,但A组升高更明显(P<0.05)。A组患者总并发症发生率为19.15%明显高于B组的4.26%,差异有统计学意义(P<0.05)。结论不同倾斜角度头高脚低位腹腔镜下子宫内膜异位症手术对手术时间、苏醒时间、丙泊酚用量、瑞芬太尼用量均无明显影响,但后倾20°较后倾30°对患者动脉血气分析指标、血流动力学参数、眼内压影响更小且并发症发生率更低。

Objective To investigate the effects of different body positions on arterial blood gas indexes of patients undergoing laparoscopic endometriosis surgery.Methods A total of 94 patients with endometriosis who underwent laparoscopic surgery in our hospital from February 2018 to May 2020 were enrolled in the study,who were divided into group A and group B according to random number table,with 47 cases in each group.The patients in both groups adopted the same method for induction of anesthesia.After the pneumoperitoneum was completed,the patients in both groups took the head high and feet low position.The shaking table was retroversioned 30°in group A,and 20°in group B to start the operation.The general operation conditions,arterial blood gas indexes,hemodynamic parameters,intraocular pressure and adverse reactions were observed and compared between the two groups.Results There were no significant differences in operation time,recovery time,propofol dosage,and remifentanil dosage between the two groups(P>0.05).The pH and PaO_(2) in both groups were significantly decreased at 30 min after postural change,moreover,the decrease degree in group A was more significant,and the partial pressure of carbon dioxide in both groups was significantly increased,and the increase degree in group A was more significant(P<0.05).Moreover the mean arterial pressure in both groups was decreased significantly,and the decrease degree in group B was more significant.The heart rate in both groups was increased significantly,and the increase degree in group B was more significant.In addition the intraocular pressure in both groups was increased significantly,and the increase degree in group A was more significant(P<0.05).The incidence rate of complications in group A was 19.15%(9/47),which was significantly higher than that[4.26%(2/47)]in group B(P<0.05).Conclusion The laparoscopic endometriosis surgery with different tilt angles has no significant effects on the operation time,recovery time,propofol dosage and remifentanil dosage,however,the effects of retroversion 20°are less than those of retroversion 30°,and the incidence rate of adverse reactions in former is lower.