泌尿外科腹腔镜手术CO2 气腹对血气的影响及处理

[目的]探讨泌尿外科腹腔镜手术CO2气腹对血气分析的影响和处理。[方法]腹腔镜手术77例,其中后腹腔镜组35例,腹腔镜组20例和术前应用NaHCO3腹腔镜组22例三组。采用全麻,术中CO2气腹压力维持在13~14 mmHg。设立3个监测时点,术前5 min（Ⅰ）、术中30 min（Ⅱ）、术后30 min（Ⅲ）,进行血气分析监测,观察并记录pH、PCO2、PO2、BE。[结果]本组12例皮下气肿,5例手术时间〉2 h,3例体重〉90 kg,5例年龄〉70岁,均发生高碳酸血症。后腹腔镜组Ⅱ、Ⅲ中pH、PCO2与Ⅰ相比明显下降。腹腔镜组Ⅱ、ⅢpH与Ⅰ相比明显下降,PCO2明显上升。腹腔镜与后腹腔镜组相比术中pH降低更明显,PCO2上升更明显,差异有显著性意义（P〈0.01）,表明腹腔镜组比后腹腔镜组更易引起高碳酸血症。两组术后均有轻度高碳酸血症。同法,术前应用NaHCO3腹腔镜组与前两组相比术中pH明显升高,PCO2明显下降,BE明显升高,差异有显著性意义（P〈0.01）。[结论]术前控制慢性病,缩短手术时间,术后即刻排空气体,减少皮下气肿发生,术前应用NaHCO3有利于控制术中CO2对血气的影响。经腹腔途径比后腹腔途径更易发生高碳酸血症,因此,对于泌尿外科腹腔镜手术,应注意选择手术入路。

Effect of using CO2 pneumoperitonum in laparoscopic urinary surgery on arterial blood gas and its treatment

[Objective] To study the influence of CO2 pneumoperitonum to arterial blood gas in laparoscopic urinary surgery and its clinical treatment.[Methods] Seventy-seven patients with laparoscopic surgery were divided into 3 groups.Thirty-five cases were in group of the retroperitoneal approach,20 cases were in the transperitioneal approach and 22 cases(12 of them with retroperitoneal approach and 10 with transperitioneal approach) were given with 5% sodium bicarbonate 30 minutes before the laparoscopic surgery.Ge...