腹腔镜与后腹腔镜CO2气腹对患者血流动力学及血气的影响

【摘要】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血气的影响。 方法 选择经腹腔和经腹膜后腔入路手术患者各50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的变化。 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）均较气腹前有显著性差异（P<0.05）。组间比较无差异（P>0.05）。两组患者组内气腹后30、60min患者动脉血二氧化碳分压（PaCO2）较气腹前明显增加，pH明显下降（P<0.05）。组间比较腹膜后腔组变化更明显（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，术中需加强呼吸管理和内环境监测。

Affect of carbondioxide neumoperitonium of laparoscope and retroperitoneal laparoscope on hemodynamics and blood gas

Objective To explore the influence of CO2 insufflation on hemodynamics and arterial blood gas in laparoscopic surgery and retroperitoneal laparoscopic surgery.Methods Fifty cases underwent retroperitoneoscopic urologic surgery and 50 cases underwent laparoscopic urologic surgery..Hemodynamics and arterial blood gas were measured at four points:time before CO2 insufflation,30 and 60 minutes after insufflations establishment,30 minutes after exsufflation.Results In the two groups,HR,MAP and CVP were increased significantly at 30 and 60 minutes after insufflations(P<0.05),while no significant difference was found between the two groups(P>0.05).In the two groups and between the two groups,pH was decreased and PaCO2 increased significantly at 30 and 60 minutes after insufflations(P<0.05).Conclusion Retroperitoneal CO2 insufflation produces more effects on the hemodynamics and arterial blood gas in the patients undergoing surgery.Specical attention should be paid to respiration administration and internal environment monitoring in the operation.