老年妇科腹腔镜手术气腹、体位及高碳酸血症对循环功能的影响

目的探讨老年妇科腹腔镜手术术中气腹、体位改变及高碳酸血症对患者循环功能的影响。方法选取80例老年妇科腹腔镜手术患者为研究对象,均给予气管插管全麻及术中机械通气,分别在麻醉后15 min、T位后15 min、平卧气腹后15min、过度通气后15 min、过度通气后30 min检测患者的MAP、HR、pH、PETCO2、PaCO2、Pa-ETCO2。结果MAP、HR与PaCO2在平卧气腹后15 min时较麻醉后15 min提高,过度通气后15 min与30 min较平卧气腹后15 min降低(P<0.05);pH在T位后15 min与平卧气腹后15 min较麻醉后15 min降低,在过度通气后15 min、30 min较平卧气腹后15 min提高(P<0.05);PETCO2、Pa-ETCO2在平卧气腹后15 min较麻醉后15 min提高,过度通气后15 min、30 min较平卧气腹后15 min降低(P<0.05)。结论腹腔镜手术术中构建气腹、体位改变及高碳酸血症均会对循环功能产生一定影响,需加强术中监测并科学调整呼吸机参数,以改善患者循环功能,促进患者康复。

Impact of Pneumoperitoneum,Posture and Hypercapnia on Circulatory Function in Elderly Gynecological Laparoscopic Surgery

Objective To explore the impact of intraoperative pneumoperitoneum,posture change and hypercapnia on circulatory function in elderly patients with gynecological laparoscopic surgery.Methods 80 elderly patients with gynecological laparoscopic surgery were selected as the study objects.All patients were given general anesthesia with tracheal intubation and intraoperative mechanical ventilation.MAP,HR,pH,PETCO2,PaCO2 and Pa-ETCO2 were detected at 15 min after anesthesia,15 min after T position,15 min after supine pneumoperitoneum,15 min after hyperventilation and 30 min after hyperventilation respectively.Results The MAP,HR and PaCO2 at 15 min after supine pneumoperitoneum were significantly higher than those at 15 min after anesthesia,15 min after hyperventilation and 30 min after hyperventilation(P<0.05).The pH at 15 min after supine pneumoperitoneum and 15 min after T position were significantly lower than those at 15 min after anesthesia,and the pH at 15 min after supine pneumoperitoneum was significantly lower than that at 15 min after hyperventilation and 30 min after hyperventilation(P<0.05).The PETCO2 and Pa-ETCO2 at 15 min after supine pneumoperitoneum were significantly higher than those at 15 min after anesthesia,15 min after hyperventilation and 30 min after hyperventilation(P<0.05).Conclusions Pneumoperitoneum construction,posture change and hypercapnia during laparoscopic surgery will have certain impact on the circulatory function.It is necessary to strengthen intraoperative monitoring and scientifically adjust ventilator parameters to improve the circulatory function and promote the rehabilitation of patients.