后腹腔镜CO2气腹对全麻患者血流动力学及血气的影响

目的 :探讨后腹腔镜手术CO2 气腹对全麻患者血流动力学及动脉血气的影响。方法 :选择后腹腔镜下行肾及肾上腺手术患者 2 0例 ,监测气腹前、气腹后 30、6 0min和放气后 30min血流动力学指标和动脉血气的变化。结果 :气腹后 30、6 0min患者平均肺动脉压 (mPAP)、肺小动脉楔压 (PAWP)和中心静脉压(CVP)均较气腹前显著增加。气腹前后心率、平均动脉压、心排指数 (CI)、体循环血管阻力指数 (SVRI)、肺血管阻力指数 (PVRI)和左心室收缩功能指数 (LVSWI)无显著性差异 (P >0 0 5 )。气腹后PaCO2 较气腹前明显增加 ,pH明显下降 (P <0 0 5 )。结论 :后腹腔镜CO2 气腹对全麻患者血流动力学和动脉血气有一定影响 ,术中需加强监测和管理。

The influence of retroperitoneal CO2 insufflation on hemodynamics and arterial blood gas in posterior retroperitoneoscopic surgery

Objective:To explore the influence of retroperitoneal CO 2 insufflation on hemodynamics and arterial blood gas in posterior retroperitoneoscopic surgery.Methods:20patients undergoing elective retroperitoneoscopic urologic surgery were studied.Hemodynamics(thermodilution technique)and arterial blood gas were measured at four time points:time before retroperitoneal CO 2 insufflation,30and60minutes after retroperitoneal insufflation,30minutes after exsuffla-tion.Results:Retroperitoneal insufflation resulted in a singificant increase of mean pulmonary arterial pressure,pulmonary arterywedge pressure,and central venous pressure.PaCO 2 was increased and arterial pH decreased significantly(P<0.05).Conclusions:Retroperitoneal CO 2 insufflation produces some effects on the patients’s hemodynamics and respiratory function.Special attention should be paid to reduce the hemodynamic changes and avoid hypercapnia.