不同压力CO_2气腹下腹腔镜胃癌根治术对患者血气指标的影响分析
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摘要
目的比较不同压力CO_2气腹对腹腔镜胃癌根治术患者血流动力学和动脉血气等方面的影响。方法选择2014年6月至2016年12月本院收治的早期或局部进展期远端胃癌患者130例,按照随机数字表法将患者分为三组,术中CO_2气腹压维持在低压力组(6～8 mmHg)、中压力组(9～11 mmHg)和高压力组(12～14 mmHg)。比较三组患者在气腹前(T1),气腹后60min(T2)、气腹后120 min(T3)、放气后60 min(T4)时点HR、平均动脉压(MAP)、pH、PaO_2和PaCO_2等指标变化情况及术中心律失常、高碳酸血症、皮下气肿和气栓等不良反应发生情况。结果与T1比较,三组患者在T2、T3、T4时点HR和MAP均升高,差异有统计学意义(P<0.05);中压力组和高压力组患者在T2、T3、T4时点HR、MAP及PaCO_2高于同一时点低压力组,差异有统计学意义(P<0.05),三组患者各时点pH值和PaO_2差异无统计学意义(P>0.05);高压力组术中心律失常发生率高于低压力组和中压力组(P<0.05)。结论 CO_2气腹压力6～8 mmHg有利于维持腹腔镜胃癌根治术患者术中血流动力学平稳,对PaCO_2影响较小。
Objective To compare the effect of different pressure CO_2 pneumoperitoneum on hemodynamics and arterial blood gas in patients with laparoscopic gastrectomy. Methods 130 cases of patients with advanced or locally advanced distal gastric cancer in our hospital from June,2014 to December,2016 were selected and divided into three groups according to the random number table. The pressures of C02 pneumoperitoneum were set at 6-8, 9-11 and 12-14 mmHg in low pressure group, middle pressure group and high pressure group. The charnges of heart rate(HR), mean arterial pressure( MAP), pH, partial pressure of oxygen(PaO_2) and partial pressure of carbon dioxide(paCO_2) in three groups were measured before pneumoperitoneum(T1), 60 minutes after pneumoperitoneum(T2), 120 minutes after pneumoperitoneum(T3) and 60 minutes after discharge( T4). The complications of the three groups, such as abnormal intraoperative rhythm, hypercapnia, subcutaneous emphysema and air embolism were compared.Results Compared with T1,the HR and MAP of the three groups increased at T2, T3 and T4 points(P <0. 05); The levels of HR, MAP and PaCO_2 in T2, T3 and T4 points were higher in the middle pressure group and the high pressure group than that in the low pressure group at the same time point( P < 0. 05);There was no significant difference in pH value and PaO_2 among the three groups(P > 0. 05); The incidence of central arrhythmia in the high pressure group was higher than that in the low pressure group and the middle pressure group(P < 0. 05). Conclusions The pressure of 6-8 mmHg CO_2 pneumoperitoneum is conducive to maintain the hemodynamic stability of patients with laparoscopic gastrectomy and less impact on the PaCO_2.
Objective To compare the effect of different pressure CO_2 pneumoperitoneum on hemodynamics and arterial blood gas in patients with laparoscopic gastrectomy. Methods 130 cases of patients with advanced or locally advanced distal gastric cancer in our hospital from June,2014 to December,2016 were selected and divided into three groups according to the random number table. The pressures of C02 pneumoperitoneum were set at 6-8, 9-11 and 12-14 mmHg in low pressure group, middle pressure group and high pressure group. The charnges of heart rate(HR), mean arterial pressure( MAP), pH, partial pressure of oxygen(PaO_2) and partial pressure of carbon dioxide(paCO_2) in three groups were measured before pneumoperitoneum(T1), 60 minutes after pneumoperitoneum(T2), 120 minutes after pneumoperitoneum(T3) and 60 minutes after discharge( T4). The complications of the three groups, such as abnormal intraoperative rhythm, hypercapnia, subcutaneous emphysema and air embolism were compared.Results Compared with T1,the HR and MAP of the three groups increased at T2, T3 and T4 points(P <0. 05); The levels of HR, MAP and PaCO_2 in T2, T3 and T4 points were higher in the middle pressure group and the high pressure group than that in the low pressure group at the same time point( P < 0. 05);There was no significant difference in pH value and PaO_2 among the three groups(P > 0. 05); The incidence of central arrhythmia in the high pressure group was higher than that in the low pressure group and the middle pressure group(P < 0. 05). Conclusions The pressure of 6-8 mmHg CO_2 pneumoperitoneum is conducive to maintain the hemodynamic stability of patients with laparoscopic gastrectomy and less impact on the PaCO_2.
引文
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[8]Nesek-Adam V,Vnuk D,Rasic Z,et al.Comparison of the effects of low intra-abdominal pressure and pentoxifylline on oxidative stress during C02 pneumoperitoneum in rabbits[J].Eur Surg Res,2009,43(4):330-337.DOI:10.1159/000237747.
[2]Madsen MV,Istre 0,Staehr-Rye AK,et al.Postoperative shoulder pain after laparoscopic hysterectomy with deep neuromuscular blockade and low-pressure pneumoperitoneum:A randomised controlled trial[J].Eur J Anaesthesiol,2016,33(5):341-347.DOI:10.1097/EJA.0000000000000360.
[3]廉伟,孙静林,刘彦涛.不同气腹压对小儿腹腔镜手术PETC02、MAP及心率的影响[J].陕西医学杂志,2017,46(9):1185-1187.DOI:10.3969/j.issn.1000-7377.2017.09.013.
[4]Miyano G,Nakamura H,Seo S,et al.Pneumoperitoneum and hemodynamic stability during pediatric laparoscopic appendectomy[J].J Pediatr Surg,2016,51(12):1949-1951.DOI:10.1016/j.jpedsurg.2016.09.016.
[5]崔贺华,刘云贺,何笑雨.二氧化碳气腹压对行腹腔镜胆囊切除术患者血流动力学及胃肠功能影响[J].新乡医学院学报,2016,33(4):321-324.DOI:10.7683/xxyxyxb.2016.04.019.
[6]Hong Y,Xin Y,Yue F,et al.Randomized clinical trial comparing the effects of sevoflurane and propofol on carbon dioxide embolism during pneumoperitoneum in laparoscopic hepatectomy[J].Oncotarget,2017,8(16):27502-27509.DOI:10.18632/oncotarget.15492.
[7]Kobayashi S,Honda G,Kurata M,et al.An Experimental Study on the Relationship Among Airway Pressure,Pneumoperitoneum Pressure,and Central Venous Pressure in Pure Laparoscopic Hepatectomy[J].Ann Surg,2016,263(6):1159-1163.DOI:10.1097/SLA.0000000000001482.
[8]Nesek-Adam V,Vnuk D,Rasic Z,et al.Comparison of the effects of low intra-abdominal pressure and pentoxifylline on oxidative stress during C02 pneumoperitoneum in rabbits[J].Eur Surg Res,2009,43(4):330-337.DOI:10.1159/000237747.