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1、CO2气腹及体位对呼吸循环功能影响【摘要】目的比较腹腔镜胆囊切除术(LC)与腹腔镜妇科手术中CO2气腹及体位对血流动力学及呼吸动力学的影响。方法选择ASAⅠ-Ⅱ级择期行腹腔镜胆囊切除术、腹腔镜妇科手术患者各30例，分为LC组(A)和腹腔镜妇科手术组(B)，两组均予静吸复合全麻维持麻醉，记录麻醉诱导前、插管后3min、平卧位气腹后3min、体位改变后3min、平卧位放气后3min的心率(HR)、血压(BP)、氧饱和度(SPO�2)、气道压及PETCO2，并抽取桡动脉血行血气分析测定PaO�2、PaCO2、pH，并对所得资料进行统计学处理。结果与气腹前相比
2、，气腹后两组患者的BP、HR均增高，但两组间差异无统计学意义；两组患者的气道压、PETCO2、PaCO2在气腹后明显高于气腹前(P<0.05)，而B组病例T位气腹后PAW、PETCO2及PaCO2显著高于A组(P<0．05)；两组患者pH值在气腹后各时点及放气后3min明显降低(P<0．05)。结论在应用腹腔镜进行胆囊切除或妇科手术时，CO2气腹对呼吸循环功能均有一定的影响，而妇科手术时的Trendelenburg体位又较LC的头高位对呼吸功能的影响更明显。【关键词】腹腔镜；气腹；呼吸功能；循环功能；胆囊切除；妇科手术TheeffectofCO2pne
3、umoperitoneumandposition8onrespiratoryfunctionandhemodynamicduringlaparoscopiccholecystectomyandlaparoscopicgynecologicoperationHUANGFeng-zhen，TANGHong.DepartmentofAnesthesiology,XixiangHospital,People’shospital,Shenzhen510082,China【Abstract】ObjectiveTostudytheeffectofCO2pneumop
4、eritoneumandpositiononrespiratoryfunctionandhemodynamicduringlaparoscopiccholecystectomyandlaparoscopicgynecologicoperationundergeneralanesthesia.MethodsASAⅠ-Ⅱpatientsundergoinglaparoscopiccholecystectomyandlaparoscopicgynecologicoperationwereselectedanddividedintotwogroupswith3
5、0patientsrespectively.GroupAwasthelaparoscopiccholecystectomygroupandgroupBwasthelaparoscopicgynecologicgroup.Anesthesiawasmaintainedwithpropofolandisoflurane.RecordedtheHR,BP,SPO�2,PETCO2,PaCO2,PaO�2,pHandairwaypressureatthetimepointofbeforeinduction,3minafterintubation,3minaft
6、erpneumoperitoneum,3minafterpositingand3minafterdeflation.ResultsComparedwiththosebefore8pneumoperitoneum,BPandHRincreasedsignificantlyinbothgroupsafterpneumoperitoneum(P<0.05),anddidnotdiffermuchbetweengroupAandgroupB.Theairwaypressure,PETCO2andPaCO2increasedinbothgroupsafterpn
7、eumoperitoneumandthoseingroupBafterTrendelenburgpositionincreasedsignificantlythanthoseingroupA.ConclusionCO2pneumoperitoneumshoesacertaineffectonrespiratoryfunctionandhemodynamicinlaparoscopicoperation,andtheeffectsafterTrendelenburgpositioninlaparoscopicgynecologicoperationwer
8、esignificantlythanthoseinlaparoscopiccholecyste
