腹腔镜下前列腺癌根治术中呼气末CO2分压的变化及意义

目的观察腹腔镜前列腺癌根治术中动脉血CO2分压（PaCO2）与呼气末CO2分压（PetCO2）差值Pa-ETCO2变化及其临床意义。方法腹腔镜前列腺癌根治术患者28例，于气管插管全身麻醉下完成手术，术中PETCO2维持在30～35mmHg左右，分别在麻醉后（T0），气腹第30min（T1），60min（T2），120min（T3），180min（T4）取桡动脉血行血气分析测PaCO2，据监测的PETCO2及血气分析获得的PaCO2，计算每个时间点的Pa-ETCO2。结果气腹后各时间点PaCO2，MBP，PPEAK，Pa-ETCO2明显增高（P〈0．05），人工气腹60min后，Pa-ETCO2发生显著变化（P〈0．01），部分患者出现CO2蓄积。气腹后PH值明显下降（P〈0．01）。结论腹腔镜前列腺癌根治术中人工气腹60min后PETCO2不能真实反映PaCO2，当PETCO2维持在30-35mmHg时应监测PaCO2避免发生高碳酸血症。

Difference between arterial and end-tidal carbon dioxide pressures in laparoscopic radical prostarectome

Objective To compare the difference between arterial carbon dioxide pressure（ PaCO2）and end-tidal carbon dioxide pressure （PETCO2）（Pa-ETCO2） at different time during laparoscopic radical prostatectome （LRP）. Methods 28 patients with LRP according to montsouris technique were enrolled. Pulmonary ventilation was adjusted that made PETCO2 at 30 to 35 mm Hg during the procedure. Arterial blood gas analysis was performed after anesthesia and 30, 60, 120 ,180 minutes after CO2 insufflation , Pa-ETCO2 was calculated at each time. Results The mean value of PaCO2 and Pa-ETCO2 were 40.4±2.4 mm Hg and 7.7± 2.6 mm Hg, respectively, before carbon dioxide p PaCO2 and Pa-ETCO2 increased significantly at 60 minutes after CO2 insufflation, part of the patients with hypercapnia. Conclusions Monitoring end-tidal carbon dioxide pressure is not enough to guide ventilation during LRP surgery. Respiratory acidosis may occur when PETCO2 was maintained at 30 to 35 mm Hg during carbon dioxide pneumoperitoneum, then PaCO2 must be monitored.