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不同体位腹腔镜手术对动脉血-呼气末二氧化碳分压差的影响
The influence of different posture on the arterial-end tidal carbon dioxide gradient during the laparoscopic operation

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DOI:
作者:
王赟
Wang yun
作者单位:
上海市第一人民医院
Department of Anesthesia, First People’s Hospital of Shanghai
关键词:
腹腔镜；体位；动脉血-呼气末二氧化碳分压差；
laparoscopic operation; posture; arterial-end tidal carbon dioxide gradient;
摘要:
目的：观察腹腔镜手术气腹时头高位或头低位对动脉血-呼气末二氧化碳分压差（Pa-ETCO2）的影响，探讨呼气末CO2监测评估动脉血CO2的精确性。方法：择期行腹腔镜手术的女性患者40例，胆囊切除术及卵巢囊肿切除术各20例。胆囊切除手术采用头高位，卵巢囊肿切除术采用头低位。术中采用容量控制通气模式，维持呼气末二氧化碳分压（PETCO2）在(35-40)mmHg之间，采集动脉血行血气分析，监测PaCO2，同时记录PETCO2，计算气腹前（T0）、气腹后30分钟（T1）的Pa-ETCO2，并比较两组Pa-ETCO2的差值。结果：在气腹前头低位和头高位组患者Pa-ETCO2无统计学差异，分别为(3.9±2.3)mmHg 和(3.2±1.6)mmHg（p＞0.05）。气腹后30分钟头低位组Pa-ETCO2明显高于头高位组，分别为(7.5±2.7) mmHg和(5.3±1.7)mmHg（p＜0.05）。结论：腹腔镜手术时头低位组较头高位组Pa-ETCO2差别更大，术中应调整呼吸参数保持更低的PETCO2。
Objective: To observe the effects of different posture on the arterial-end tidal carbon dioxide gradient (Pa-ETCO2) during the laparoscopic operation, and to investigate the accuracy of estimating arterial carbon dioxide(PaCO2) from end tidal carbon dioxide(PETCO2). Methods: Forty female patients, scheduled for elective laparoscopic cholecystectomy in Trendelenburg position and laparoscopic gynecologic surgery in Verse Trendelenburg position under general anesthesia were included in this study. The patients were allocated into two groups according to their posture during surgery (n=20 for each group). All patients received volume-controlled ventilation during anesthesia, and the PETCO2 were controlled at the level between (35 to 40) mmHg. PaCO2 and PETCO2 were measured and recorded both at the moment before the pneumoperitoneum(T0) and after 30 minutes(T1). The Pa-ETCO2 gradients in each group was calculated and compared. Results: There was no difference in Pa-ETCO2 gradients between the two groups before pneumopertoneum( (3.9±2.3)mmHg vs (3.2±1.6) mmHg，P＞0.05). However, the Pa-ETCO2 of the Trendelenburg position group increased significantly greater than in the other group( (7.5±2.7 vs 5.3±1.7mmHg，P＜0.05). Conclusion: The PETCO2 need to be maintained at a lower level in the patients undergoing laparoscopy surgery in Trendelenburg position during the operation.

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