腹腔镜与后腹腔镜CO2气腹对患者血流动力学及CO2排除量的影响

目的:探讨经腹腔和经腹膜后腔入路手术CO2气腹对患者血流动力学及CO2排除量的影响。方法:选择经腹膜后腔(A组)和经腹腔(B组)入路手术患者各35例,监测气腹前、气腹后30min、60min和气腹结束后30min血流动力学和动脉血气以及不同时段机体对CO2的排除量。结果:两组患者组内气腹后30min、60min患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)均较气腹前差异显著,有统计学意义(P<0.05),组间比较无统计学意义(P>0.05)。两组患者组内气腹后30 min、60min患者动脉血二氧化碳分压(PaCO2)和CO2排除量较气腹前明显增加,pH明显下降(P<0.05)。且A组在60min明显高于B组(P<0.05)。结论:经腹膜后腔入路手术CO2气腹对患者血流动力学和动脉血气的影响更大,后腹腔镜手术更容易引起高碳酸血症,术中需加强呼吸管理和内环境监测。

Effects of CO2 insufflation on hemodynamics and depletion rate of CO2 in laparoscopic surgery and retroperitoneal laparoscopic surgery

Objective: To explore the influence of CO2 insufflation on hemodynamics and depletion rate of CO2 in laparoscopic surgery and retroperitoneal laparoscopic surgery.Methods: 35 cases of retroperitoneoscopic urologic surgery and 35 cases of laparoscopic urologic surgery were selected.Hemodynamics and arterial blood gas were measured before CO2 insufflation,30 and 60 minutes after insufflations,and 30 minutes after the end of insufflation.The depletion rate of CO2 in different time point of operation was calculated based on formula.Results: HR,MAP and CVP were increased significantly 30 and 60 minutes after insufflations(P<0.05),in both groups while no significant difference was found between the two groups(P>0.05).pH was decreased,PaCO2 and depletion rate of CO2 increased significantly 30 and 60 minutes after insufflations(P <0.05) in both groups.Compared with group B,the PaCO2 and depletion rate of CO2 in group A obviously increased at 60 min utes(P< 0.05).Conclusion:Retroperitoneal CO2 insufflation produces more effects on patient’s hemodynamics and arterial blood gas,there fore retroperitoneoscopic operation is more likely to induce hypercapnia than laparoscopic operation.Special attention should be paid to respiration manipulation and internal environment monitoring in the operation.