完全腹膜外腹腔镜疝修补术中呼气末二氧化碳分压变化观察.docVIP

完全腹膜外腹腔镜疝修补术中呼气末二氧化碳分压变化观察 　【摘要】 　　目的：观察完全腹膜外腹腔镜疝修补术麻醉中呼气末二氧化碳分压（ＰＥＴＣＯ２）的变化。方法：２００５年１０月至２００６年１２月为１１例患者于气管插管麻醉下行腹腔镜腹膜外疝修补术（total extraperitoneal prosthesis,TEP)，术中监测ＰＥＴＣＯ２值。结果：充气后１０min ＰＥＴＣＯ２升高，６０min达高峰（４７.２０±１.５５）mm Hg，充ＣＯ２气体后１０、３０、６０、９０、１２０min ＰＥＴＣＯ２均较充气前有统计学差异（Ｐ＜０.０１）；６０min后ＰＥＴＣＯ２开始下降，９０min达到稳定水平：放气后１０min接近充气前水平（Ｐ＞０.０５）。结论：ＴＥＰ术中腹膜外充ＣＯ２时，ＰＥＴＣＯ２明显升高，ＣＯ２气体吸收较多，但尚在正常范围。 【关键词】 疝　腹股沟　疝修补术　二氧化碳分压　腹腔镜术 　　The change of ＰＥＴＣＯ２ during laparoscopic total extraperitoneal prosthesis 　　【Abstract】Ｏbjective:To observe the changes of ＰＥＴＣＯ２ during laparoscopic total extraperitomeal prosthesis under general anesthesia.Methods:A total of 11 patients in endotracheal intubation anesthesia underwent laparoscopic tolal extraperitoneal prosthesis from Oct.2005 to Dec.2006.ＰＥＴＣＯ２ were monitored during the operation.Results：ＰＥＴＣＯ２ began to increase at 10min after the insufflation,and reached the peak at 60min.Compared with that before the insufflation,statistically difference were observed about ＰＥＴＣＯ２ at 10,30,60,90,120min after the insufflation(Ｐ＜０.０１）.After 60min,ＰＥＴＣＯ２ began to decrease and maintained at stable levels at 90min,and descended to the levels before the insufflation at 10min after the deflation.Conclusions：It is significantly higher of ＰＥＴＣＯ２ when the space out of the peritoneum are full of carbon dioxide during the operation,much carbon dioxide are absorpted,but the pressure are still within the normal ranges. 　　【Key words】Hernia,inguinal;Herniorrhaphy;Carbon dioxide partial pressure;Laparoscopy 完全腹膜外腹腔镜疝修补术是在腹膜与腹壁间分离一腔隙，充入ＣＯ２气体后，植入人工网片修补疝的一种方法，具有术后患者康复快，复发率低，无腹腔粘连等优点。２００５年１０月至２００６年１２月，我院为１１例患者行完全腹膜外腹腔镜疝修补术，为了解对ＰＥＴＣＯ２的影响从而掌握ＣＯ２吸收的情况，降低并发症，提高麻醉安全性，从而对麻醉期间ＰＥＴＣＯ２的变化进行了观察记录，现报道如下。 　　１ 资料与方法 　　１．1 临床资料 　　本组１１例中男９例，女２例；３４～７２岁，体重４３～７９kg，ＡＳＡ Ⅰ～Ⅱ级，均无心肺疾患。其中腹股沟斜疝１０例，直疝１例。术中充气时间４６～１２０min。 　　１．２ 麻醉方法与监测 　　术前肌注苯巴比妥钠１００mg，阿托品０.５mg，麻醉前更换钠石灰。１１例全部采用气管插管静吸复合全麻，用多参数监护仪监测ＮＩＢＰ、ＥＣＧ、SpO２及主流式ＰＥＴＣＯ２。诱导静脉注射咪达唑仑０.０３～０.０６mg/kg、丙泊酚１.５mg/kg、芬太尼３～５μg/kg、维库溴胺０.１５mg/kg。气管插管后接麻醉机，机械通气参数：（ＶＴ）８～１０ml/kg