腹腔镜胆囊切除术二氧化碳气腹对动脉血气的影响.doc

腹腔镜胆囊切除术二氧化碳气腹对动脉血气和呼气末二氧化碳分压的影响 敖翔 陆诚 段宏伟 上海市南汇区中心医院麻醉科（201300） [摘要] 目的 观察腹腔镜胆囊切除术(LC)手术期间CO2气腹对患者动脉血气和呼气末二氧化碳分压（PETCO2）的影响。方法 选择行腹腔镜胆囊切除术患者48例，ASAⅠ~Ⅱ级，于气腹前10min和气腹后15min、30min以及放气后30min分别采取桡动脉血，测定血气，同时记录PETCO2。结果 与气腹前10min比较，气腹后15min和30min PaCO2及PETCO2均显著性增加（p0.05）,PH值、PaO2等指标无明显变化（p0.05）；放气后30min各项指标均恢复到气腹前水平。结论 腹腔镜胆囊切除术CO2气腹期间，PETCO2和PaCO2均显著性增加，提示可能存在高碳酸血症，应加强PETCO2的监测。 [关键词] 腹腔镜 ； 胆囊切除术 ； 动脉血气；高碳酸血症 Effects of carbon dioxide insufflation on arterial blood gas and PETCO2 during laparoscopic cholecystectomy Ao Xiang, Lu Cheng, Duan Hongwei. Department Of Anesthesiology, Nanhui Central Hospital of shanghai,Nanhui 201300 [Abstract] Objective To investigate the effects of carbon dioxide insufflation on arterial blood gas and PETCO2 during laparoscopic cholecystectomy(LC). Methods Forty-eight patients with ASA grade Ⅰ‐Ⅱ undergoing LC were selected. The values of arterial porital pressure of oxygen(PaO2),carbon dioxide(PaCO2) and PH were measured 10min before the insufflation,15min and 30min after the insufflation and 30min after the deflation,respectively. The values of PETCO2 were recorded at the same time. Results Compared with those before the insufflation, PaCO2 and PETCO2 were increased significantly 15min and 30min after insufflation(p0.05), the differences of PH and PaO2 were not obviously significant(P0.05),all markers returned to the basal level 30min after the deflation. Conclusion PaCO2 and PETCO2 were increased with the insufflation of carbon dioxide during LC,which indicated the occurrence of hypercapnia，more attention should been paid to the monitor of PETCO2。 [Key words] Laparoscopic; Cholecystectomy; Arterial blood gas; Hypercapnia 腹腔镜胆囊切除术(LC)具有手术时间短、创伤小、恢复快等优点，自1991年以来，我国各地已广泛开展，但其可能存在的并发症也不容忽视[1]，本研究采用动脉血气分析和同时监测PETCO2，以期了解气腹前后动脉血二氧化碳分压和呼气末二氧化碳分压的变化，为临床提供理论数据。 资料和方法 一般资料 选择ASA Ⅰ~Ⅱ级胆囊结石或胆囊息肉择期行腹腔镜胆囊切除术的患者48例，男18例，女30例，年龄（43±12）岁，体重（51.3±9.2）Kg，术前心肺功能及生化检查均无异常。 麻醉与监测 术前半小时肌肉注射苯巴比妥钠0.1g、阿托品0.5mg，入室后常规测量血压、心率、脉搏氧饱和度，开放