腹腔镜胆囊切除术与腹腔镜妇科手术中麻醉、体位、CO_2气腹对血流动力学及呼吸动力学影响的比较研究

Effect of anesthesia, position,CO_2 pneumoperitoneum on hemodynamic changes and respiratory mechanics during laparoscopic cholecystectomy and laparoscopic gynecologic operation

目的：观察腹腔镜胆囊切除术(LC)与腹腔镜妇科手术中麻醉、体位、CO2气腹对血压、心率、SpO2、PetCO2、气道压的影响。方法：选择ASAⅠ～Ⅱ级择期行腹腔镜胆囊切除术，腹腔镜妇科手术病人各38例，予以异丙酚、异氟醚维持麻醉，分别于诱导前、插管后即刻、插管后5min、气腹后3min、8min及气腹放气后平卧位记录血流动力学及呼吸动力学参数。结果：两组插管后5min血压、心率明显低于诱导前；气腹后3min、8min血压、PetCO2、气道压明显高于插管后5min(P<0．01)。两组之间相比，妇科手术气道压、PetCO2显著高于LC组(P<0．01)。结论：腹腔镜妇科手术呼吸动力学的改变明显大于LC组，血流动力学改变两组间无显著差异。

objective To observe the effect of anesthesia、position、CO2 pneumoperitoneum of BP、HP、SpO2、PetCO2、airway pressure during laparoscopic cholecystectomy and laparoscopic gynecologic operation . Methods : ASA -Ⅱ patients undergoing laparoscopic cholecystectomy of laparoscopic gynecologic operation were selected in this study ,38 patients in each group. Anesthesia were maintained with propofol and isoflurane. The parameters of hemodynamic and respiratory mechanics were recorded before induction,shortly, 5 min after intubation ,3 min and 8 min after pneumoperitoneum and after deflation . Results Bp and HR decreased significantly at 5 min after intubation , compared with those before induction ( P < 0.01) . BP 、 PetCO2、airway pressure at 3 min and 8 min after pneumoperitoneum increased significantly,compared with those at 5 min after intubation (P<0. 01). Compared with laparoscopic cholecystectomy group, PetCO2,airway pressure in the laparoscopic gynecologic operation group increased significantly (P<0.01) . Conclusions The changes of respiratory mechanics in the laparoscopic gynecologic operation group were significantly larger than laparoscopic cholecystectomy group, but the hemodynamic changes did not differ much in the two groups.