呼末二氧化碳分压监测在后腹腔镜手术中的作用

目的 探讨呼末二氧化碳分压(PETCO2)监测在后腹腔镜手术中的作用.方法 回顾分析72例择期行后腹腔镜手术的患者,依据PaCO2监测结果将患者分为两组,A组:各监测时点PaCO2＜60 mmHg;B组:气腹后至少有一个时间点PaCO2＞60 mmHg.分别于气腹前(T1)、气腹后30 min(T2)、60 min (T3)、90 min (T4)时记录各时间点的PaCO2、PETCO2,根据PETCO2及PaCO2计算每个时间点的Pa-ETCO2.结果 两组间比较:T1、T2时间点B组患者的PaCO2、PETCO2、Pa-ETCO2较A组无统计学差异(P＞0.05),T3、T4时间点B组患者的三项监测指标较A组有统计学差异(P＜0.05).两组组内比较:A组,T2-4与T1相比较,PaCO2、PETCO2、Pa-ETCO2均有统计学差异(P＜0.05),T3与T2、T4与T3、T4与T2比较三项监测指标均无统计学差异(P＞0.05):B组,T2-4与T1相比较,PaCO2、PETCO2、Pa-ETCO2均有统计学差异(P＜0.05或P＜0.01),随着气腹时间的延长,PaCO2、PETCO2两项监测指标均逐渐升高,T3与T2、T4与T3、T4与T2比较PaCO2有统计学差异(P＜0.05),PETCO2 T4与T2比较有统计学差异(P＜0.05).结论 后腹腔镜手术气腹后患者的PaCO2、PETCO2、Pa-ETCO2均会升高,尤其是体重指数＞30 kg/m2、术前肺功能检查轻至中度阻塞性通气障碍、术中发生皮下气肿的患者,PaCO2、PETCO2随时间的延长而呈进行性升高,单靠PETCO2监测不能完全满足对患者的监测需要,术中应该辅以动脉血气分析监测PaCO2.

Effect of end-tidal carbon dioxide pressure monitoring in retroperitoneoscopyic surgery

Objective To study the value of end-tidal carbon dioxide pressure monitoring in retroperitoneoscopyic surgery. Methods Seventy-two patients scheduled for retroperitonesocopy were retrospectively studied. The patients were divided into two groups according to the level of PaCO2. Group A: PaCO2 was not surpassed 60 mmHg after CO2 insufflation. Group B: PaCO2 was surpassed 60 mmHg at one or more time point after CO2 insufflation. Before pneumoperitoneum(T1), 30(T2), 60(T3) and 90 min(T4) after CO2 insufflation PaCO2 and PETCO2 were recorded witj Pa-ETCO2 was calculated at each time according to PaCO2 and PETCO2. Results Group B compared with group A: At T1 and T2, PaCO2, PETCO2 and Pa-ETCO2 in group B showed no significant difference compared with group A (P>0.05). At T3 and T4, the three parameters of monitoring in group B showed significant differences compared with group A (P<0.05). Between-group comparison: In group A, T2-4 compared with T1, PaCO2, PETCO2, Pa-ETCO2 were significanly lower (P<0.05). T3 compared with T2, T4 compared with T3, T4 compared with T2, three parameters of monitoring showed no significant difference (P> 0.05). In group B, T2-4 compared with T1, PaCO2, PETCO2, Pa-ETCO2 were significanly lower (P<0.05 or P<0.01). PaCO2 and PETCO2 gradually increased with pneumoperitoneum time, T3 compared with T2, T4 compared with T3, T4 compared with T2, PaCO2 showed significantly different (P<0.05), T4 compared with T2, PETCO2 showed significantly different (P<0.05). Conclusions PaCO2, PETCO2, Pa-ETCO2 increased after CO2 insufflation during retroperitoneoscopyic surgery. Particularly for those patients, who were body mass index >30 kg/m2, mild to moderate obstructive ventilatory defect showed in preoperative pulmonary function tests, with subcutaneous emphysema in surgery, PaCO2 and PETCO2 progressively increased with time after CO2 insufflation. PETCO2 monitoring couldn’t meet the need of monitoring. Arterial gas analysis monitoring PaCO2 should be used to help in retroperitoneoscopy.