腹腔镜用于妇科手术时CO_2气腹对循环系统及心肌酶谱的影响

Influence of CO_2 Pneumoperitoneum on Respiratory System and Myocardial Enzymogram

目的 :探讨腹腔镜用于妇科手术时人工 CO2 气腹对患者平均动脉压 ( MAP)、心率 ( HR)及心肌酶谱的影响。方法 :选择 40例妇科卵巢瘤、子宫内膜异位症择期手术的患者。随机分为 CO2气腹组 ( 组 )、非气腹组 ( 组 )。在麻醉方法相同情况下 ,分别观察诱导前、气腹前、气腹后 5、1 0、30 min时 HR、收缩压、舒张压、MAP、脉搏血氧饱和度 ( Sp O2 )、呼吸末 CO2 分压 ( PETCO2 )及术前和术后 8h的心肌酶谱的变化。结果 : 组气腹 5、1 0、30 min,MAP较诱导前差异有显著性( P<0 .0 1 )。两组间比较差异也有显著性 ( P<0 .0 5 )。 组气腹 1 0 min后 HR变化明显 ( P<0 .0 1 ) ,两组间比较差异有显著性 ( P<0 .0 5 )。 组术后 8h谷草转氨酶 ( AST)、磷酸肌酸激酶 ( CK)、肌酸激酶同工酶 ( CK- MB)值较术前有明显增高 , 组增高不明显。结论 :人工 CO2 气腹可以使 MAP升高 ,HR增快 ,心肌酶谱改变。因此 ,腹腔镜手术中 ,一定要注意防止气腹压力过高所诱发的心肌缺血性损伤 。

Objective: To explore the effect of artificial carbon dioxide (CO 2) pneumoperitoneum on mean arterial pressure (MAP), heart rate (HR), and myocardial enzymogram during gynecological operation with laparoscope. Methods:40 cases of gynecological patients with ovarian tumors and endometriosis were selected. The patients were randomly divided into two groups: Group Ⅰ (CO 2 pneumoperitonium) and Group Ⅱ (non pneumoperitonium). Under the same anesthestic condition, the alterations of HR, systolic pressure, diastolic pressure, MAP, arterial oxygen saturation, and expiratory end CO 2 pressure (P ET CO 2) before anesthetic induction and 5,10 and 30 min after pneumoperitonium, respectively, and the alteration myocardial enzymogram before and 8 hours after operation were monitored. Results: 5,10 and 30 min after CO 2 pneumoperitonium in group Ⅰ, the level of MAP was significantly different from pre induction, and the HR was also significantly different from group Ⅱ at the same time point. The HR was markably changed 10 min after pneumoperitonium in group Ⅰ, and was significantly different from group Ⅱ. Comparing with preoperation, the level of AST,CK and CK MB significantly increased 8 hours after operation in group Ⅰ, whereas they didn′t significantly increase in group Ⅱ. Conclusion: The artificial CO 2 pneumoperitonium may increase MAP, elevate HR, and alterate myocardial enzymogram. Therefore, special emphasis should be placed upon preventing from ischemia heart injury induced by elevated pressure during gas laparoscopy, especially for those patients with coronary artery disease and hypertension.