不同二氧化碳气腹压对腹腔镜妇科手术病人动脉血气、血流动力学及应激状态的影响

张京硕; 金丽芳

doi:10.13898/j.cnki.issn.1000-2200.2021.11.013

不同二氧化碳气腹压对腹腔镜妇科手术病人动脉血气、血流动力学及应激状态的影响

Effect of different carbon dioxide pneumoperitoneum pressure on the arterial blood gas, hemodynamics and stress status of patients treated with laparoscopic gynecological surgery

摘要

摘要:
目的探讨不同二氧化碳气腹压对腹腔镜妇科手术病人动脉血气、血流动力学及应激状态的影响。
方法选取拟行腹腔镜妇科手术病人90例，按照随机数字表法分为A组、B组、C组，各30例。腹腔镜手术中，A、B、C组分别以11、13、15 mmHg腹压进行二氧化碳气腹充气。记录各组麻醉后5 min、充气后5 min、充气后15 min、停气腹后5 min时的动脉血气指标、心率、平均动脉压、中心静脉压、外周血管阻力、心输出量，以及血清中去甲肾上腺素、皮质醇、前列腺素E₂水平。
结果C组充气后5、15 min时动脉血二氧化碳分压、心率、平均动脉压、外周血管阻力、皮质醇、去甲肾上腺素和前列腺素E₂均高于A、B组（P < 0.05~P < 0.01），中心静脉压、心输出量水平均明显低于A、B组（P < 0.01）；C组充气后15 min时HCO₃^-均明显低于A、B组（P < 0.01）。
结论中、低二氧化碳气腹压力对妇科腹腔镜手术病人的动脉血气、血流动力学及应激状态影响较小，对妇科腹腔镜手术较为适宜。

Abstract:
ObjectiveTo investigate the effects of different carbon dioxide pneumoperitoneum pressure on the arterial blood gas, hemodynamics and stress status of patients treated with laparoscopic gynecological surgery.
MethodsNinety patients scheduled by laparoscopic gynecological surgery were divided into the group A, group B and group C according to the random number table method(30 cases in each group).During laparoscopic gynecological surgery, the group A, group B and group C were inflated with 11 mmHg, 13 mmHg and 15 mmHg of carbon dioxide pneumoperitoneum pressure, respectively.The arterial blood gas index, heart rate(HR), mean arterial pressure(MAP), central venous pressure(CVP), peripheral vascular resistance(SVR), cardiac output(CO), and serum levels of orepinephrine(NE), cortisol(COR) and prostaglandin E₂(PGE₂) in three groups were recorded at 5 min after anesthesia, 5 min after aeration, 15 min after aeration and 5 min after pneumoperitoneum stop.
ResultsThe levels of PaCO₂, HR, MAP, SVR, COR, NE and PGE₂ in group C were significantly higher than those in group A and group B at 5 min and 15 min after inflation(P < 0.05 to P < 0.01), and the levels of CVP and CO were significantly lower than those in group A and group B(P < 0.01).The level of HCO₃^- in group C at 15 min after inflation was significantly lower than those in group A and group B(P < 0.01).
ConclusionsThe medium and low carbon dioxide pneumoperitoneum pressure has little effect on the arterial blood gas, hemodynamics and stress status of patients treated with gynecological laparoscopic surgery, which is suitable for gynecological laparoscopic surgery.

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