后腹膜腔镜泌尿系手术全麻对呼吸循环功能的影响及通气策略探讨

目的：观察全麻时后腹膜腔镜泌尿系手术CO2气腹对呼吸循环功能的影响及调整通气方式的作用、方法：36例患者分为3组，每组12例，麻醉后控制呼吸，VT8mL／kg，RR10bpm。Ⅱ组患者于手术开始时改变呼吸参数：VT10mL／kg，RR12bpm，Ⅲ组VT10mL/kg，RR14bpm，Ⅰ组则保持呼吸参数不变。于麻醉前、CO2气腹前、气腹后10、30、45、60min记录BP、HR、SpO2、PETCO2、PaCO2和pH。结果：与充气前比较BP、HR3组均升高（P〈0．05），但组间比较差异无统计学意义（P〉0．05）：PETCO2Ⅰ、Ⅱ组充分后各时点与麻醉前相比持续升高（P〈0．05～0．01），45～60min达高峰。Ⅲ组于30min内升高不明显（P〉0．05），但其后逐渐升高（P〈0．05）。组间比较，Ⅰ组上升幅度最大，Ⅱ组次之，Ⅲ组在30min后才有明显上升，而且上升幅度低于Ⅰ、Ⅱ组（P〈0．05），但Ⅰ、Ⅱ组间差异无统计学意义（P〉0．05）；pH、PaCO2呈现相似的变化。结论：通气增加潮气量和呼吸频率的过度通气方式，可以在一定程度上减轻CO2吸收导致的高碳酸血症或酸中毒，Ⅲ组的通气方式效果更明显、

The Influence of Retroperitoneal Laparoscopic Operation on Respiratory and Circulatory System

Objective： To evaluate the influence of retroperitoneal laparoscopic surgery on respiratory and circulatory function and ventilation mode. Methods： 36 patients were divided into three groups, the ventilation was 10ml/kg,the respiration rate was 12 bpm. In group Ⅱ , the respiratory parameters was VT10mL/kg and RR12bpm; in group Ⅲ , the respiratory parameters was VT10mL/kg and RR14bpm; The BP, HR, SpO2, PETCO2, PaCO2 and pH of the patient were monitored. Results： BP and HR of the patient increased after insufflation（ P 〈 0.05） , no significant difference was found between each gruup（P 〉0.05）. PETCO2 in group Ⅰ and Ⅱ increased significantly after anesthesia and reached peak value in 45 -60 minutes. A significant increase was found in In group Ⅰ , so was group Ⅲ , a increase was found in group m after 30 minutes. Conclusion： High tidal volume ventilation and respiration rate are effective for the alleviation of hypercapnia and acidosis.