悬吊式腹腔镜妇科手术对患者呼吸、循环功能的影响

目的观察悬吊式腹腔镜妇科手术对患者呼吸、循环功能的影响。方法依据手术方式不同,将50例,美国麻醉师学会(ASA)分级为Ⅰ～Ⅱ级,无呼吸、循环系统疾病史的妇科患者分为两组,每组25例。Ⅰ组于全麻下行CO2气腹腹腔镜手术;Ⅱ组于全麻下行非气腹腹腔镜手术。监测两组患者麻醉前(T0)、麻醉后5min(T1)、气腹或悬吊建立后10min(T2)、30min(T3)、气腹或悬吊撤除后5min(T4)5个时点的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)、呼气末二氧化碳分压(PETCO2)、气道压力(Paw)的变化。结果 T0、T1时点两组各监测指标差异无统计学意义(P>0.05),T2、T3时点Ⅰ组MAP、HR、PETCO2、Paw明显升高,差异有统计学意义(P<0.05),T4时点Ⅰ组PETCO2明显高于Ⅱ组(P<0.05)。结论 CO2气腹对呼吸、循环功能有一定影响,悬吊式腹腔镜则可免除这种影响。

Effects of suspended laparoscopic gynecological surgery on respiratory and circulatory function

Objective To investigate the effects of suspended laparoscopic gynecological surgery on the respir- atory and circulatory function. Methods 50 ASA Ⅰ-Ⅱ cases of normal circulatory and respiratory function undergo- ing gynecological laparoseopic operation were divided into the group Ⅰ and Ⅱ according to the operation modes, 25 cases in each group. The group Ⅰ was performed COz pneumoperitoneum under general anesthesia,while the group II was performed non-pneumoperitoneum under general anesthesia. The changes of systolic blood pressure（SBP）, dias- tolic blood pressure（DBP）, mean arterial pressure（MAP）, heart rate（ HR）, oxygen saturation（ SPO2 ）, end-tidal car- bon dioxide partial pressure（of PETCO2） and airway pressure（Paw） were measured at five time points including be- fore anesthesia（T0）,5 min after anesthesia（T1）,10 min（T2）,30 min（T3） after the establishment of pneumoperito- neum or suspension,5 min after pneumoperitoneum or suspension removal（T4）. Results There were no differences at TO and T1 between these two groups（P〉0.05）. MAP, HR,PETCO2 ,Paw at T2 and T3 in the group Ⅰ were higher than those in the group Ⅱ ,difference showing statistical significance（P〈0.05）. PETCO2 at T4 in the group was obviously higher than that in the group Ⅱ （P〈0.05）. Conclusion CO2 pneumoperitoneum has some effects on the respiratory and circulatory function,while suspended laparoscopy can avoid these effects.