天津医药

• 短篇论著 • 上一篇    下一篇

泌尿外科腹腔镜手术期间长时程CO2气腹对PetCO2与PaCO2相关性的影响

王冰艳,吕国义   

  1. 天津医科大学第二医院麻醉科
  • 收稿日期:2011-08-18 修回日期:2012-05-11 出版日期:2012-09-15 发布日期:2012-09-15
  • 通讯作者: 王冰艳

Effect of pneumo-peritoneum with CO2 lasting long time course on correlation of PaCO2 and PetCO2 during Urological laparoscopic surgery

,Guo-Yi LV   

  • Received:2011-08-18 Revised:2012-05-11 Published:2012-09-15 Online:2012-09-15

PDF (PC)

2494

摘要： 摘要 目的：探讨泌尿外科腹腔镜手术期间长时间CO2气腹下PetCO2是否能精确反映PaCO2，及随气腹时间延长二者的相关性。方法：选择泌尿外科腹腔镜全麻手术患者40例，ASAⅠ～Ⅱ级，术前无心肺功能异常，气腹时间>3h。常规诱导插管，观察并记录诱导插管后，气腹1、2、3h及气腹结束前、气腹结束后0.5h的PetCO2和PaCO2数值，建立回归方程，总结不同时点二者相关性的变化。结果：插管后、气腹后1、2h及气腹结束后0.5h，PetCO2 与PaCO2呈显著正相关（r=0.966，P<0.01）。但随气腹时间延长，PetCO2 与PaCO2监测数值均升高，PaCO2增幅显著大于PetCO2，二者相关性变差（r=0.585，P< 0.01）。结论：泌尿外科腹腔镜CO2气腹下手术围术期PetCO2监测结果与PaCO2相关性良好，能正确反映气腹条件下患者PaCO2变化趋势，满足临床监测需求。但随气腹时间延长，PetCO2与PaCO2差值增大，相关性变差，故当气腹时间超过3h，除应常规监测PetCO2外，推荐依据血气分析结果及时调整呼吸参数，防止高碳酸血症发生。

关键词: PetCO2, PaCO2, 气腹, 泌尿科腹腔镜手术

Abstract: Objectives：To appraise whether arterial partial pressure of end—tidal carbon dioxide(PetCO2) can accurately reflect the value of arterial partial pressure of carbon oxide(PaCO2) during prolonged laparoscopic procedure and the correlation between them. Methods：40 ASA physical status I and II patients，without cardio-pulmonary dysfunction preoperatively，scheduled for elective urologic laparoscopic procedures, pneumo-peritoneum course lasted over 3 hours. After conventional induction and tracheal intubation, the values of PetCO2 and PaCO2 were observed and recorded at post-intubation, at 1, 2 and 3 hr. point post-pneumoperitoneum, right half hr. at the end of pneumo-peritoneum. Then, regression formula was built in correlation between PetCO2 and PaCO2 at different time-point. Results: A remarkable positive correlation between PetCO2 and PaCO2 was found at the point of post-intubation, 1 and 2 hr. post-pneumoperitoneum, and half hr. at the end of post-pneumoperitoneum（r=0.966，P<0.01）. But as time prolonged, the correlation between PetCO2 and PaCO2 changed badly, there was an increase in the values of both PetCO2 and PaCO2, but the increase range was much higher in PaCO2 than that of in the PetCO2 （r=0.585，P< 0.01）.Conclusions: There was a better correlative relationship in monitoring results between PetCO2 and PaCO2 during the laparoscopic procedure of urology under pneumoperitoneum with carbon oxide, which can correctly reflect the tendency of change of PaCO2 under the condition of pneumoperitoneum, that can meet clinical use, but the D-value increases and correlation went to bad between PetCO2 and PaCO2 as pneumoperitoneum duration prolonged. So,besides conventional monitoring PetCO2, respiratory parameters should be modulated in time according to the results of blood gas analysis in order to avoid hypercapnia when pneumoperitoneum duration lasted over 2 hours.

Key words: PetCO2, PaCO2, pneumoperitoneum, Urological laparoscopic surgery