二氧化碳气腹对不同手术患者血流动力学的影响

目的　观察腹腔镜胆囊切除术(LC)与腹腔镜妇科诊治术(LP)中二氧化碳气腹、体位对血压、心率、脉搏血氧饱和度(　SpO2)的影响.方法选择ASA分级Ⅰ～Ⅱ级行LC患者(LC组,12例)及LP患者(LP组,13例).予丙泊酚、芬太尼、恩氟烷、阿曲库铵维持麻醉与肌松,分别记录术前、充气后即刻、调整体位后、充气后30　min、放气后的收缩压、舒张压、心率、SpO2.结果LC组患者充气后即刻、调整体位后及充气后30　min收缩压、舒张压收缩压:(138.75±13.22)、(　140.42±15.88)、(　138.67±16.35)　mm　Hg(1mm　Hg　=0.133　kPa);舒张压:(94.42±5.76)、(96.25±8.26)、(90.42±7.36)　mm　Hg]均较术前收缩压:(135.50±15.31　)mm　Hg;舒张压:(83.58±6.70)　mmHg]升高(P＜0.01),LP组患者调整体位后及充气后30　min收缩压、舒张压收缩压:(136.76±12.55)、(136.85±13.22)　mm　Hg;舒张压:(88.38±6.54)、(87.23±6.34)　mm　Hg]均较术前收缩压:(132.52±10.11)　mm　Hg;舒张压:(74.61±5.23)mmHg]升高(P＜　0.05)；两组各时间点心率、SpO2比较差异均无统计学意义(P＞0.05).结论LC与LP由于麻醉、体位、二氧化碳人工气腹的影响,在气腹后收缩压、舒张压均明显高于术前,但两者比较差异无统计学意义.

Effect of carbon dioxide pneumoperitoneum on hemodynumics in patients with different operation

Objective To investigate the influence of carbon dioxide pneumoperitoneum,posture on blood pressure,heart rate (HR),pulse oxygen saturation (SpO2) of laparoscopic cholecystectomy (LC)and gynecologic surgery (LP) patients.Methods Twelve LC patients (LC group)and 13 LP patients(LP group) with ASA Ⅰ - Ⅱ were selected.Anesthesia and muscle relaxation were maintained by propofol,fentanyl,enflurane,atracurium and the systolic pressure (SBP),diastolic pressure (DBP),HR,SpO2 was recorded in the following times:before anesthesia (T0),immediately after inflation (T1),after position adjustment (after 10 win inflation ) (T2),after 30 min inflation ( T3 ),after deflation (the end of operation)(T4).Results The SBP and DBP at T1,T2,T3 SBP:(138.75 ± 13.22),(140.42 ± 15.88),(138.67 ±16.35) mm Hg( 1 mm Hg =0.133 kPa) ; DBP:(94.42 ± 5.76),(96.25 ± 8.26),(90.42 ± 7.36) mm Hg] was higher than that at T0SBP:( 135.50 ± 15.31 ) mm Hg;DBP:(83.58 ± 6.70) mm Hg] in LC group(P＜ 0.01 ).The SBP and DBP at T2,T3 SBP:(136.76 ± 12.55),(136.85 ± 13.22) mm Hg;DBP:(88.38 ±6.54),(87.23 ± 6.34) mm Hg ] was higher than that at T0 SBP:( 132.52 ± 10.11 )mm Hg; DBP:(74.61 ± 5.23 )mm Hg] in LP group (P ＜ 0.05 ).There was no significant difference in HR,SpO2 between T0 and the other points in two groups (P ＞ 0.05).Conclusion The hemodynamic changes have no significant difference between LC and LP;but compared with preoperative,the hemodynamic changes have significant difference after inflation.