腹膜后腔镜手术并发高二氧化碳血症的临床观察

目的观察腹膜后腔镜手术高二氧化碳血症的发生情况,分析其相关因素,为麻醉管理提供指导。方法选取择期腹膜后腔镜手术患者40例,观测并记录气腹前（T0）、气腹后30min（T1）、气腹后60min（T2）、气腹后90min（T3）、停气腹后30min（T4）各时点的心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、呼气末二氧化碳分压（PETCO2）、血氧饱和度（SpO2）;并同时行动脉血气分析,观察PH值、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）的变化;如患者合并皮下气肿,对其严重程度进行分级。结果全手术过程中所有患者的PaO2均〉100mmHg,SpO2均为100%,患者的HR、SBP、DBP和MAP基本平稳。与T0相比,T1、T2、T3患者PaCO2和PETCO2呈进行性升高,pH明显降低（P〈0.05）,T1、T2、T3高二氧化碳血症（PaCO2〉50mmHg）发生率分别为10%、41%、75%;30例发生皮下气肿,其中轻度13例、中度12例、重度5例,5例重度皮气肿患者PaCO2最高超过80mmHg,PETCO2最高超过50mmHg;另有1例术中出现气胸。结论腹膜后腔镜手术易发生高二氧化碳血症,气腹时间、皮下气肿严重程度等都为相关因素,提示麻醉期间应警惕高二氧化碳血症,以早期发现、及时处理。

The clinical observation of retroperitoneoscopic surgery complicated with hypercapnia

Objective In orde to provide guidance for the anesthetic management,we observed the situation of retroperitoneoscopic surgery complicated with hypercapnia and analyzed its relevant factors. Methods We selected 40 cases of patients as the object of research that had undergone retroperitoneoscopic surgery,and then we detected heart rate（HR）,systolic blood pressure（SBP）, diastolic blood pressure（DBP）,mean arterial pressure（MAP）,end-tidal pressure of carbon dioxide（PETCO2）,blood oxygen saturation（SpO2） at the time point before pneumoperitoneum （T0）, 30 min after pneumoperitoneum （T1）,60 min after pneumoperitoneum（T2）,90 min after pneumoperitoneum （T3）,and 30 min after stop the pneumoperitoneum（T4）. We also detected arterial blood gas analysis and observed the changes of pH, partial pressure of O2（PaO2）, and arterial partial pressure of carbon dioxide（PaCO2）. The severity classification would be implemented if the patients were complicated with subcutaneous emphysema. Results In the surgical procedure, the PaCO2 values in all patients was exceed 100 mmHg, and the SPO2 values was 100%. HR, SBP, DBP and MAP were basically stable. As compared with the values at T0,PaCO2 and PETCO2 at T1-T3 were significantly increased while PH was significantly decreased. The incidence of hypercapnia at T1 was 10%, T2 41%, and T3 75%. 30 cases of patients were suffered with subcutaneous emphysema （13 cases mild, 12 cases moderate, 5 cases severe）, and 1 person complicated by pneumothorax. Conclusions The retroperitoneoscopic surgery is prone to hypercapnia. The time of pneumoperitoneum and the severity of subcutaneous emphysema were became the risk factors, which prompted us that anesthesia during hypercapnia should be alert to have early detection and timely treatment.