达芬奇机器人腹腔镜肾切除手术的麻醉体会

Anesthesia experiences on laparoscopic nephrectomy with da Vinci S robotics

目的:总结达芬奇机器人肾切除术20例的麻醉经验。方法:对四川省人民医院2014年8—11月入院的20例达芬奇机器人肾切除术麻醉过程进行分析,记录麻醉时间、手术时间、气腹时间及二氧化碳分压(Pa CO2)和呼气末二氧化碳分压(PETCO2)。结果:20例机器人手术麻醉,麻醉时间为(220±14)min,手术时间为(187±11)min,CO2气腹时间为(180±13)min;Pa CO2和PETCO2在手术开始1.5 h后明显高于基线(气腹建立前)时(P<0.05);p H在手术开始后2.5 h后与基线时相比明显降低(P<0.05);吸气时气道峰压在CO2气腹建立后0.5 h明显高于基线时(P<0.05)。结论:达芬奇机器人肾切除术术中血流动力学较平稳,但气腹时间明显延长,患者气道阻力相比气腹前明显增高,且容易发生酸碱失衡。

Objective:To summarize the clinical anesthesia experiences in 20 patients who underwent laparoscopic nephrectomy with da Vinci S robotics.Methods:Anesthesia data of 20 patients from Sichuan Provincial People's Hospital,who underwent laparoscopic nephrectomy with da Vinci S robotics from August 2014 to November 2014,were analyzed and summarized.The anesthesia time,operation time,CO_2 pneumoperitoneum time,PaCO_2 and P_(ET)CO_2 were recorded.Results:All patients were anesthetized and underwent surgery with da Vinci S robotics.The anesthesia time was(220±14) min,the operation time was(187±11) min,and the CO_2pneumoperitoneum time was(180±13) min.The PaCO_2 and PETCO_2 were significantly elevated at 1.5 h after operation compared with those at the baseline(before pneumoperitoneum)(P<0.05).The pH value was significantly decreased at 2.5 h after operation compared to that at the baseline(P<0.05).The peak airway pressure of inspiration was significantly elevated at 0.5 h after the beginning of pneumoperitoneum compared to that at the baseline(P<0.05).Conclusion:The hemodynamics is stable during the laparoscopic nephrectomy with da vinci S robotics.However,the duration of CO_2 pneumoperitoneum is significantly increased compared to that of other surgical procedures,resulting in high airway resistance and acid-base disturbance.