腔镜气腹与无气腹手术麻醉机CO_(2)吸收剂的临床比较研究

Clinical Comparative Study on CO_(2) Absorber of Anesthesia Machine for Endoscopic Pneumoperitoneum and Non-Pneumoperitoneum Surgery

目的研究腔镜下CO_(2)气腹对麻醉机中CO_(2)吸收剂钠石灰使用时间的影响,为临床腔镜气腹手术更换钠石灰提供依据。方法随机纳入我院2021年2—8月ASA分级Ⅰ~Ⅲ级,年龄18~70岁,择期无心肺疾病、中枢系统疾病和非肥胖[体质量指数(Bady Mass Index,BMI)<28 kg/m^(2)]的全麻患者193例。根据手术是否使用CO_(2)气腹将入选患者分为腔镜气腹组和无气腹组。以校准后的监护仪CO_(2)气体监测FiCO_(2)达到5%且患者呼气末二氧化碳分压(Pressure of End-Tidal CO_(2),PetCO_(2))和动脉血气值均在正常合理范围内为钠石灰的更换标准,记录钠石灰的使用时间并进行统计学分析。结果钠石灰的有效使用时长气腹组[(2976.1±158.4)min]明显低于无气腹组[(3870.3±173.1)min],差异有统计学意义(P<0.05),且两组钠石灰更换前后的重量基本一致,差异无统计学意义(P>0.05)。结论全麻下腔镜CO_(2)气腹手术相较无气腹腔镜手术钠石灰的有效使用时间明显缩短;值得关注的是腔镜下CO_(2)气腹手术FiCO_(2)达到5%后PetCO_(2)会迅速升高,较无气腹腔镜手术钠石灰更换的时间安全窗口变窄,一旦发现需要及时更换,否则患者会有引发高碳酸血症的危险。

Objective To study the effect of carbon dioxide(CO_(2))pneumoperitoneum under endoscopy on the use time of CO_(2) absorber soda lime in anesthesia machine,and provide basis for replacing soda lime in clinical endoscopic pneumoperitoneum surgery.Methods A total of 193 general anesthesia patients with ASA gradeⅠtoⅢ,aged 18 to 70 years old,without cardiopulmonary disease,central system disease and non-obesity[body mass index(BMI)<28 kg/m^(2)],who were admitted to our hospital from February to August 2021 were randomly selected.The selected patients were divided into endoscopic pneumoperitoneum group and non-pneumoperitoneum group according to whether CO_(2) pneumoperitoneum was used for surgery.When the FiCO_(2) value of the calibrated monitor reach 5%,the partial pressure of end-tidal CO_(2)(PetCO_(2))and arterial blood gas value of the patients were within the normal and reasonable range,it was the replacement standard of soda lime.The service time of soda lime was recorded and statistically analyzed.Results The effective use time of sodium lime in pneumoperitoneum group[(2976.1±158.4)min]was significantly lower than that in non-pneumoperitoneum group[(3870.3±173.1)min],the difference was statistically significant(P<0.05).The weight of soda lime before and after replacement in the two groups was basically the same,and difference was not statistically significant(P>0.05).Conclusion The effective use time of soda lime in endoscopic CO_(2) pneumoperitoneum under general anesthesia is significantly shorter than that in non-pneumoperitoneum.It is noteworthy that PetCO_(2) will rise rapidly after the FiCO_(2) reaches 5%in CO_(2) pneumoperitoneum under endoscopy,which narrows the time safety window of soda lime replacement compared with non-pneumoperitoneum.Once it is found that it needs to be replaced in time,otherwise the patient will be at risk of hypercapnia.