不同气腹压下长时间CO2气腹对呼吸循环的影响

目的：探讨不同气腹压（IAP）下长时间的C0：气腹对呼吸循环的影响，为今后开展腹腔镜下高难度手术积累经验及提供理论依据。方法：40例ASA Ⅰ～Ⅱ级手术时间在180min以上的腹腔镜胆囊切除术（LC）患者随机分低气腹压力（10±1mmHg）组（L组）和高气腹压力（15±1mmHg）组（H组），每组20例。用咪唑安定1～2mg、芬太尼2μg·kg、异丙酚2．0～2．5mg·kg^-1、维库溴铵0．1mg·kg^-1陕速诱导插管，术中吸入1．5％～2％异氟醚，间断给予芬太尼，维库溴铵维持麻醉。记录两组患者气腹前，气腹后30、60、90、120、150、180min和放气后5min时的心率（HR）、收缩压（SBP）、脉搏氧饱和度（SpO2）、气道峰压（PPeak）、肺顺应性（Compl）、呼气末二氧化碳分压（PetCO2）及预设MV与实际MV的差值（AMV）等指标。结果：气腹后各时间点两组患者S。0：变化不明显，HR、SBP、PPeak、PetCO2及△MV较气腹前有明显增高，Compl明显降低，H组比L组更显著。气腹后PetCO2随时间推移呈“S”型上升，H组平台期较L组短而不明显。结论：长时间高CO2气腹压对呼吸循环影响大，PetCO2升高快，所以提高腹腔镜手术技巧，尽量缩短手术时间，且在低气腹压下完成手术，能减少对患者的创伤，促进早日康复。

The Effect of Long-time CO_2 Pneumoperitoneum on Respiratory and Circulation System under Different Intra-abdominal Pressure

Objective： To investigate the influnce of long-time laparoscopy on respiratory and circulation system under different insuflation pressure,accumulating experience and providing scientific basis for carrying out the more difficult laparoscopy from now on. Methods： Forty patients of LC time over 180min, ASA Ⅰ-Ⅱ , were randomly divided into 2 groups （20 in each group） according to the pressure during pneumoperitoneum：group low 10± lmmHg（LH） and group high 15 ± 1mmHg（GH）. Anesthesia was induced with midazolam form 1 to 2 mg,propofol 2.0-2.5 mg ·kg^-1 , fentanyl 2 μg · kg^-1 and veeumnium 0.1 mg · kg^-1 and maintained from 1.5% to 2.0% isoflurane inhalation and intermittent IV boluses of {entanyl and vecuronium after tracheal intubation. HR, SBP, SpO2. PPeak（airway peak pressure）, Compl （lung Compliance）, Pet CO2 and /k MV（ the part that set MV minus ture MV leaves） were recorded before insufflation, at 30,60,90,120,150,180min after insufflation and 5 min after exsufflation. Results：SpO2 was not markedly different between two group at each time of prei-insufflation. H R,SBP,PPeak,PetCO2 and △MV（the part that set MV minus ture MV leaves） at each time after insufflation were significantly higher ,while was lower than those at the time of before insufflation,especially in H group. PetC02 after insufflation and insufflation time presen-ted ＇S＇, type curvilinear relationship,but the plateau in H group was shorter and more irregular than that in L group. Conclusions： The long-time laparoscopy under higher IAP results in more significant effects in respiratory and circulation system ,especially on PetCO2. If we improve laparoseopic technique as soon as possible to shorten operative time,and if we carry out laparoscopy under lower IAP , we should reduce damage of organism and promote recovery earlier