腹腔镜肝切除术中二氧化碳气腹对循环、PETCO2和血气值的影响及围术期麻醉处理

目的探讨腹腔镜肝切除术中CO2气腹对循环、PETCO2和血气值的影响及术中术后的相关情况.方法腹腔镜肝切除手术病人14例,采用气管内插管全麻.分别于气腹前,气腹后30min、60min、120min,放气腹后10min、30min记录MAP、HR、CVP、PETCO2,气道压及血气值.观察手术时间、气腹时间、术中出血量及术后住院天数等情况.结果各时段与气腹前相比,MAP、CVP无显著变化;HR、PETCO2、PaCO2、K+气腹后30min明显高于气腹前(P＜0.05),pH值气腹后30min明显低于气腹前(P＜0.05),气道压气腹后均高于气腹前(P＜0.05).结论 CO2气腹导致的高碳酸血症及酸中毒,通过调整分钟通气量、给予NaHCO3可得到纠正.

Influences of CO2 pneumoperitoneum on circulation, PETCO2, and blood gas during laparoscopic hepatectomy

Objective To investigate the effects of CO 2 pneumoperitoneum on circulation, P ET CO 2 and blood gas during laparoscopic hepatectomy. Methods Fourteen patients underwent laparoscopic hepatectomy with CO 2 pneumoperitoneum. The MAP, HR, CVP, P ET CO 2 , airway pressure and blood gas were monitored respectively before, 30min, 60min, 120min after pneumoperitoneum, and 10min and 30min after deflation of the abdomen. Results The HR, P ET CO 2 , PaCO 2 , and plood K + were significantly higher 30min after pneumoperitoneum compared with the values before pneumoperitoneum (P<0.05). The blood pH was significantly lower 30min after pneumoperitoneum than that of before pneumoperitoneum (P<0.05). All the values pertinent to airway pressure were significantly higher after pneumoperitoneum than before it (P<0.05). Conclusions CO 2 pneumoperitoneum may produce hypercapnia and acidosis, but they can be corrected by regulation of respiratory minute volume and infusion of NaHCO 3 .