过度通气在腹腔镜手术中临床应用.docVIP

过度通气在腹腔镜手术中的临床应用湖北省汉川市人民医院 刘欣 何春霞 431600 [摘要] 目的 观察过度通气在腹腔镜手术中的应用，减少高碳酸血症的发生，减轻患者术后不适。方法 妇科腹腔镜手术60例，外科腹腔镜手术60例，泌尿外科腹腔镜手术30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)运用过度通气。监测两组PETCO2、气道压(Paw)。结果 两组患者气腹后PETCO2与Paw都较气腹前高，但A组PETCO2与Paw升高更明显；B组PETCO2基本维持在正常范围内。两组同时点比较差异有非常显著性（P0.01）。结论 过度通气在腹腔镜手术中的应用，可以减少发生高碳酸血症的危险，大大减轻了腹腔镜CO2气腹术后患者不适。 [关键词] 过度通气 腹腔镜手术 气腹 呼气末CO2分压 [Abstract] Objective To observe the effect of using hyperventilation on PETCO2 of gynecological laparoscopic surgical patients after-carbon dioxide pneumoperitonem. Methods 150 cases, were randomly divided into two groups. Group A:maintaining a fixed respiratory parameter in the whole operation.Group B:using hyperventilation according to PETCO2.At the same time,PETCO2,Paw of all patients were detected.Results In two groups PETCO2 after carbon dioxide pneumoperitoneum were significantly higher than PETCO2before pneumoperitoneum.But in group A PETCO2 was above the normal rang.Furthermore, after pneumoperitoneum,PETCO2 in group A were significantly higher than that in group B.It was the same in Paw.Conclusion Hyperventilation could cause PETCO2 step-up,and it could be decreased.Meanwhile,it could reduce the possibility of hypercapnia. [Key words] hyperventilation laproscopic operation carbon dioxide pneumoperitoneum PETCO2 腹腔镜手术时CO2气腹，充入的CO2很快从腹腔吸收进入循环中。IAP较低，如1.33kpa时，CO2的吸收已经达到最大程度。CO2易溶于血，当CO2溶解后，血液呈酸性。充入的CO2及吸收的CO2只能由肺排出体外。但是在麻醉期间，吸收的CO2较少排出体外，体内积聚的大量的CO2要到苏醒期才能大量排出，大约有120LCO2贮存于体内，其中骨骼的贮存量最多。为了避免高二氧化碳血症和呼吸性酸中毒，在充入CO2时病人每分钟通气量应增加30%，人工气腹后，腹