腹腔镜胆囊切除术中二氧化碳气腹对肥胖患者呼吸和循环的影响

目的 探讨腹腔镜胆囊切除术中CO2气腹对肥胖患者呼吸和循环系统的影响。方法 择期行腹腔镜胆囊切除手术患者80例，其中体质量正常组（A组）20例，术中气腹压力设定为14mmHg；肥胖患者组（B组）60例，根据气腹压力不同又分为B，组（12mmHg）、B2组（14mmHg）和风组（15mmHg），每组20例。首先观察A组和B2组气腹前5min、气腹后10min，以及术毕10min时的各项血气指标，然后观察B1、B2和B3组在气腹前5min、气腹后10min，以及术毕10min时的各项血气指标和各组手术时间。结果 A组与B2组，两者分别与气腹前相比较：HR、SBP、DBP和PETC02明显上升（P〈0.01）。B2组与A组相比较，在气腹前5min，两者各指标间并无统计学意义；而在气腹后10min，B2组HR、SBP和PETC02明显增高（P〈0．01或P〈0．05），DBP、PH和SaO2指标间则无统计学意义。在B组中，各组分别与气腹前比较，HR差异有显著性（P〈0.01），而在PETCO2、SBP和DBP指标上，B1组与气腹前比较并无统计学意义，而B2和B3组则差异有显著性（P〈0.01）。在各组的组间比较中，B2和B3组与B1组相比，其HR、SBP、DBP和PETCO2各指标均有显著性增高（P〈0.01）。B2和风组的组间比较无统计学意义。手术时间比较三组间无统计学意义。结论 腹腔镜胆囊切除术中CO2气腹对肥胖患者呼吸和循环系统的影响较体重正常患者显著，术中如能选用低压气腹（12mmHg），则能明显减轻气腹对肥胖患者上述系统的影响。

Study about the effect of pneumoperitoneum on respiratory and circulation system of the obesity during laparoscopic cholecystectomy

[Objective] To study the effect of pneumoperitoneum on respiratory and circulation system of the obesity during laparoscopic cholecystectomy. [Method] 80 patients who received elective laparoscopic cholecystectomy were divided into 2 groups according to the BMI:control group (group A): BMI<25(n =20) and the pressure of CO2 was 14mmHg; obesity group(group B ): BMI<30(n =60), which was divided to three subgroups according to the pressure of CO2: group B1(12 mmHg)(n =20), group B2 (14 mmHg) (n =20), group B3(15 mmHg)(n =20). The HR, SBP, DBP, PETCO2, PH, SaO2 of group A and group B2 were analyzed at the different time: 5min before insufflation, 10 min after insufflation, 10 min after operation. The HR, SBP, DBP, PET CO2, PH, SaO2 and the operative time (OT) of group B1, B2, B3 also were analyzed at the 5 min before insufflation and 10 min after insufflation. [Result] The HR, SBP, DBP, PETCO2 of group A and group B2 was increased (P <0.01), while the DBP, PH, SaO2% were no difference compared with the preinsufflation. In group B, the HR of group B1, B2, B3 were significantly increased (P <0.01) compared with the preinsufflation. The PET CO2, SBP, DBP of group B except subgroup B1 were significantly different from the preinsufflation (P <0.01). When it comes to the comparisons among the internal of group B, the HR, SBP, DBP, PETCO2 of group B2, B3 were much higher than group B1,whereas there was no difference between the group B2 and B3.there was no difference among the three subgroups. [Conclusion] CO2 pneumoperitoneum of laparoscopic cholecystectomy results in more significant effects in respiratory and circulation system on obesity patients. A 12 mmHg CO2 pneumoperitoneum could help to reduce the effects.