呼吸参数对腹腔镜手术呼气末二氧化碳分压的影响).docVIP

呼吸参数对腹腔镜手术呼气末二氧化碳分压的影响 广东省深圳市罗湖医院麻醉科（518001） 王开俊 罗健 任俏 摘要 目的：观察腹腔镜手术气腹后调整呼吸参数对呼气末二氧化碳分压的影响。方法：腹腔镜胆囊切除术ASAI~II级患者100例，随机分成两组，A组：术中呼吸参数不变；B组：根据呼气末CO2分压（PETCO2）随时调整呼吸参数。监测两组PETCO2、气道压（Paw）、肺顺应性（Comp）。结果：两组病人气腹后PETCO2与Paw都较气腹前升高，但A组PETCO2与Paw升高更明显； B组PETCO2基本维持在正常范围内；两组同时点比较有非常显著差异（P0.01）；Comp两组都较气腹前降低，无差异。结论：调整呼吸参数可降低腹腔镜手术因CO2气腹而升高的PETCO2，减少发生高碳酸血症的危险。 关键词 腹腔镜 气腹 呼吸参数 呼吸末二氧化碳分压 Effect of adjusting respiratory parameter on PETCO2 of laproscopic surgery patients. Wang kaijun,Luo jian,Ren qiao,et,. Luohu Hospital in Shenzhen, shenzhen, 518001, China Abstract Objective：To observe the effect of adjusting respiratory parameter on PETCO2 of gynecological laparoscopic surgical patients after carbon dioxide pneumoperitoneum. Methods：100 cases, ASA grade I~II, were randomly divided into two groups. Group A：maintaining a fixed respiratory parameter in the whole operation. Group B：adjusting respiratory parameter according to PETCO2. At the same time, PETCO2, Paw and Comp.of all patients were detected. Results：In two groups, PETCO2 after carbon dioxide pneumoperitoneum were significantly higher than PETCO2 before pneumoperitoneum. But in group A, PETCO2 were above the normal range. Furthermore, at 15min, 30min, 45min after pneumoperitoneum, PETCO2 in group A were significantly higher than group B. It was the same in Paw, but there was no significant difference in Comp at different site of the process of pneumoperitoneum between two groups. Conclusion Carbon dioxide pneumoperitoneum in laparoscopic surgical could caused PETCO2 step-up, and it could be decreased by adjusting respiratory parameter. Meanwhile, it could reduce the possibility of hypercapnia. Key words Laproscopic; Carbon dioxide pneumoperitoneum; Respiratory parameter. PETCO2 腹腔镜手术时CO2气腹对呼吸循环有一定影响，CO2通过腹膜血管吸收，使体内CO2增加、呼吸末CO2分压明显升高。本文通过调整麻醉机呼吸参数以增大体内CO2排除，使呼气末CO2分压降低，现将结果报道如下。 资料与方法 1.1 一般资料 ASAI~II级腹腔镜胆囊切除术患者100例，年龄18~45岁，无心肺疾患，随机分成A、B两组，两组病人一般情况无差异。 1.2 方法 两组病人均采用全麻，以咪唑安定2~3mg、芬太尼0.1mg、 异丙酚100~150mg 、维