不同气腹压对后腹腔镜肾癌根治术患者机体的影响
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摘要
目的观察不同压力气腹对后腹腔镜肾癌根治术患者机体的影响,从而为临床选择合适的气腹压力提供理论依据。
方法选择2009年3月～2010年4月40例行后腹腔镜肾癌根治术患者,随机分为低气腹压组(LP组,10mmHg)和高气腹压组(HP组,15mmHg)。于气腹前后连续监测中心静脉压(CVP),同时监测呼气末二氧化碳分压(PetCO_2),气道压力(Paw)、胸廓顺应性(Cmpl)、脉搏(P)、血氧饱和度(SpO_2)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、体温(℃)、心电图(ECG)、采用胸骨上多普勒法心脏彩超测定心输出量(CO),并计算心脏指数(CI),每搏量(SV),体循环阻力(SVR)。分别于麻醉后气腹前5 min、气腹后30 min、排气后10 min抽取动脉血监测pH、动脉氧分压(PaO_2)、动脉二氧化碳分压(PaCO_2)、动脉血氧饱和度(SaO_2)。全血碱剩余(ABE)、标准碱剩余(SBE)。比较两组气腹前后各时间点上述呼吸、循环各项指标以及血气分析的变化情况。
结果本组40例手术均获成功,手术时间85～120 min(平均93士15min)。呼吸和血气指标的变化:两组呼吸道压力(Paw)于气腹后均显著升高(P<0.05),HP组更加明显,气腹后均恢复至气腹前水平。两组胸廓顺应性(Cmpl)于气腹后显著下降(P<0.05),HP组更加显著,放气后恢复至气腹前水平。两组呼气末二氧化碳分压(PetCO_2)于气腹后显著升高(P<0.05),且HP组更加显著。两组pH于气腹后下降,均低于7.35, HP组更显著,放气后5 minLP组恢复至气腹前水平,而HP组仍显著低于气腹前水平。两组动脉血二氧化碳分压(PaCO_2)于气腹后升高,均高于45mmHg,放气后LP恢复而HP组仍显著高于气腹前水平(P<0.05)。两组脉血氧分压(PaO_2)于气腹后无显著变化(P>0.05)。两组动脉血氧饱和度(SaO_2)、血氧饱和度(SPO_2)、全血碱剩余、标准碱剩余于气腹后无显著变化(P>0.05)。循环指标的变化:两组心率(HR)于气腹后均明显升高(P<0.05),HP组更加显著,分别维持于较高水平,放气后均恢复至气腹前水平。两组收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)均明显升高(P<0.05),但HP组更加显著,放气后5min仍未恢复至气腹前水平,而LP组己恢复。两组中心静脉压(CVP)于气腹后显著升高(P<0.05),HP组更显著,放气后均恢复至气腹前水平。两组体循环阻力(SVR)于气腹后显著升高(P<0.05),逐渐恢复至气腹前水平。两组每搏量(SV)于气腹后变化不显著(P>0.05)。两组心输出量(CO)和心脏指数(CI)于气腹后均显著升高(P<0.05),HP组更加显著,放气后5min,两组有所恢复但仍显著高于气腹前水平(P<0.05)。
结论CO_2气腹压力达到10mmHg时可以行后腹腔镜肾癌根治术,但由于气腹压力较低,手术操作过程中术野的暴露,术中出血等问题的控制有一定难度,引起手术时间较长,气腹时间延长,手术操作相对困难;但当气腹压力达到15mmHg时,由于气腹压力大,对机体的影响明显,尤其是呼吸循环系统,造成术中术后并发症的发生,因此维持气腹压力在10～15mmHg之间,术中生理指标较稳定,手术操作及患者术后恢复情况较好。
Objective:Observe different pressure of gasless laparoscopic renal patients underwent after the impact, so as to choose the appropriate gasless pressure clinical provide theoretical basis.
Methods:Choose March 2009 ~ 2010 after April 40 patients underwent laparoscopic renal routine, randomly divided into low gasless pressure groups (LP group, 10mmHg) and high gasless pressure groups (HP group, 15mmHg). In continuous monitoring center before gasless enous pressure), while monitoring (CVP expiratory at the end of the carbon dioxide points pressure (PetCO_2), airway pressure (Paw), thoracic compliance (Cmpl), pulse (P), the blood oxygen saturation (SpO_2), systolic blood pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate (HR), body temperature (℃), electrocardiogram (ECG), USES the sternum on doppler heart colour exceeds the determination method of cardiac output (CO) is calculated, and cardiac index (CI), each cardiac quantity (SV), systemic resistance (SVR). Respectively on after anesthesia measured before 5 min, after 30 min, exhaust gasless after 10 min extraction arterial monitoring, arterial oxygen partial pressure (pH PaO_2), arterial carbon dioxide points pressure (PaCO_2), spo2 on (SaO_2). The whole blood alkali surplus (ABE), standard base excess (SBE). Compare two sets of gasless around different time points above respiration, circulation index and blood gas analysis of changes.
Results:All 40 cases are performed success, operation time 85 ~ 120 min (average 93 and 15min). Breathing and flesh indexes to change: two groups of airway pressure (Paw) in gasless after were significantly increased (P < 0.05), HP group more evident, after both gasless recovered to measured before level. Two groups of thoracic compliance (Cmpl) in gasless after significantly (P < 0.05), HP group more remarkable, put gas recovery after to measured before level. Two groups expiratory at the end of the carbon dioxide points in PetCO_2) pressure (after gasless significantly increased (P < 0.05), and HP group more remarkable. Two groups of pH in gasless then down and were lower than 7.35, HP group more prominent, releasing air after five minLP group recovered to measured before level, and HP group still significantly below measured before level. Two groups of blood pressure (PaCO_2) carbon dioxide points in gasless increases, were higher than 45mmHg, put gas recovery and HP group after LP still significantly higher measured before level (P < 0.05). Two groups of arterial oxygen partial pressure (PaO_2) in gasless after did not change significantly (P > 0.05). Two groups SPO_2 on (SaO_2), the blood oxygen saturation (SPO_2), whole blood base excess, standard base excess in gasless after did not change significantly (P > 0.05). Circulation index changes: two groups of heart rate (HR) were significantly in gasless after increased (P < 0.05), HP group more remarkable, maintain high levels, respectively in bleed air after all recovered to measured before level. Two groups of systolic (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were significantly increased (P < 0.05), but HP group more remarkable, after releasing air 5min still did not return to a measured before level, while LP group has restored. Two groups of central enous pressure (CVP) in gasless after significantly increased (P < 0.05), HP group more prominent, releasing air after all recovered to measured before level. Two groups of systemic resistance (SVR) in gasless after significantly increased (P < 0.05), and gradually recovered to measured before level. Two groups of every heartbeat quantity (SV) in gasless changes after are not significant (P > 0.05). Two groups of cardiac output (CO) and cardiac index (CI) were measured after in significantly increased (P < 0.05), HP group more remarkable, after releasing air 5min, two group restore somewhat but still significantly higher measured before level (P < 0.05).
Conclusions:The CO_2 gasless pressure to achieve 10mmHg when after laparoscopic renal vesssed can do, but due to the low pressure gasless, the operation process operative field of exposure, intraoperatie bleeding problems such as the control has the certain difficulty, cause operation time is longer, gasless prolonged, the operation is relatively difficult, But when gasless pressure to achieve 15mmHg, due to gasless pressure big, to the body, especially significant respiratory system, cause operative complication, and thus maintain gasless pressure in 10 ~ 15mmHg between, intraoperative physiological indexes, more stable operation and patients recovery is better.
方法选择2009年3月～2010年4月40例行后腹腔镜肾癌根治术患者,随机分为低气腹压组(LP组,10mmHg)和高气腹压组(HP组,15mmHg)。于气腹前后连续监测中心静脉压(CVP),同时监测呼气末二氧化碳分压(PetCO_2),气道压力(Paw)、胸廓顺应性(Cmpl)、脉搏(P)、血氧饱和度(SpO_2)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、体温(℃)、心电图(ECG)、采用胸骨上多普勒法心脏彩超测定心输出量(CO),并计算心脏指数(CI),每搏量(SV),体循环阻力(SVR)。分别于麻醉后气腹前5 min、气腹后30 min、排气后10 min抽取动脉血监测pH、动脉氧分压(PaO_2)、动脉二氧化碳分压(PaCO_2)、动脉血氧饱和度(SaO_2)。全血碱剩余(ABE)、标准碱剩余(SBE)。比较两组气腹前后各时间点上述呼吸、循环各项指标以及血气分析的变化情况。
结果本组40例手术均获成功,手术时间85～120 min(平均93士15min)。呼吸和血气指标的变化:两组呼吸道压力(Paw)于气腹后均显著升高(P<0.05),HP组更加明显,气腹后均恢复至气腹前水平。两组胸廓顺应性(Cmpl)于气腹后显著下降(P<0.05),HP组更加显著,放气后恢复至气腹前水平。两组呼气末二氧化碳分压(PetCO_2)于气腹后显著升高(P<0.05),且HP组更加显著。两组pH于气腹后下降,均低于7.35, HP组更显著,放气后5 minLP组恢复至气腹前水平,而HP组仍显著低于气腹前水平。两组动脉血二氧化碳分压(PaCO_2)于气腹后升高,均高于45mmHg,放气后LP恢复而HP组仍显著高于气腹前水平(P<0.05)。两组脉血氧分压(PaO_2)于气腹后无显著变化(P>0.05)。两组动脉血氧饱和度(SaO_2)、血氧饱和度(SPO_2)、全血碱剩余、标准碱剩余于气腹后无显著变化(P>0.05)。循环指标的变化:两组心率(HR)于气腹后均明显升高(P<0.05),HP组更加显著,分别维持于较高水平,放气后均恢复至气腹前水平。两组收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)均明显升高(P<0.05),但HP组更加显著,放气后5min仍未恢复至气腹前水平,而LP组己恢复。两组中心静脉压(CVP)于气腹后显著升高(P<0.05),HP组更显著,放气后均恢复至气腹前水平。两组体循环阻力(SVR)于气腹后显著升高(P<0.05),逐渐恢复至气腹前水平。两组每搏量(SV)于气腹后变化不显著(P>0.05)。两组心输出量(CO)和心脏指数(CI)于气腹后均显著升高(P<0.05),HP组更加显著,放气后5min,两组有所恢复但仍显著高于气腹前水平(P<0.05)。
结论CO_2气腹压力达到10mmHg时可以行后腹腔镜肾癌根治术,但由于气腹压力较低,手术操作过程中术野的暴露,术中出血等问题的控制有一定难度,引起手术时间较长,气腹时间延长,手术操作相对困难;但当气腹压力达到15mmHg时,由于气腹压力大,对机体的影响明显,尤其是呼吸循环系统,造成术中术后并发症的发生,因此维持气腹压力在10～15mmHg之间,术中生理指标较稳定,手术操作及患者术后恢复情况较好。
Objective:Observe different pressure of gasless laparoscopic renal patients underwent after the impact, so as to choose the appropriate gasless pressure clinical provide theoretical basis.
Methods:Choose March 2009 ~ 2010 after April 40 patients underwent laparoscopic renal routine, randomly divided into low gasless pressure groups (LP group, 10mmHg) and high gasless pressure groups (HP group, 15mmHg). In continuous monitoring center before gasless enous pressure), while monitoring (CVP expiratory at the end of the carbon dioxide points pressure (PetCO_2), airway pressure (Paw), thoracic compliance (Cmpl), pulse (P), the blood oxygen saturation (SpO_2), systolic blood pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate (HR), body temperature (℃), electrocardiogram (ECG), USES the sternum on doppler heart colour exceeds the determination method of cardiac output (CO) is calculated, and cardiac index (CI), each cardiac quantity (SV), systemic resistance (SVR). Respectively on after anesthesia measured before 5 min, after 30 min, exhaust gasless after 10 min extraction arterial monitoring, arterial oxygen partial pressure (pH PaO_2), arterial carbon dioxide points pressure (PaCO_2), spo2 on (SaO_2). The whole blood alkali surplus (ABE), standard base excess (SBE). Compare two sets of gasless around different time points above respiration, circulation index and blood gas analysis of changes.
Results:All 40 cases are performed success, operation time 85 ~ 120 min (average 93 and 15min). Breathing and flesh indexes to change: two groups of airway pressure (Paw) in gasless after were significantly increased (P < 0.05), HP group more evident, after both gasless recovered to measured before level. Two groups of thoracic compliance (Cmpl) in gasless after significantly (P < 0.05), HP group more remarkable, put gas recovery after to measured before level. Two groups expiratory at the end of the carbon dioxide points in PetCO_2) pressure (after gasless significantly increased (P < 0.05), and HP group more remarkable. Two groups of pH in gasless then down and were lower than 7.35, HP group more prominent, releasing air after five minLP group recovered to measured before level, and HP group still significantly below measured before level. Two groups of blood pressure (PaCO_2) carbon dioxide points in gasless increases, were higher than 45mmHg, put gas recovery and HP group after LP still significantly higher measured before level (P < 0.05). Two groups of arterial oxygen partial pressure (PaO_2) in gasless after did not change significantly (P > 0.05). Two groups SPO_2 on (SaO_2), the blood oxygen saturation (SPO_2), whole blood base excess, standard base excess in gasless after did not change significantly (P > 0.05). Circulation index changes: two groups of heart rate (HR) were significantly in gasless after increased (P < 0.05), HP group more remarkable, maintain high levels, respectively in bleed air after all recovered to measured before level. Two groups of systolic (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were significantly increased (P < 0.05), but HP group more remarkable, after releasing air 5min still did not return to a measured before level, while LP group has restored. Two groups of central enous pressure (CVP) in gasless after significantly increased (P < 0.05), HP group more prominent, releasing air after all recovered to measured before level. Two groups of systemic resistance (SVR) in gasless after significantly increased (P < 0.05), and gradually recovered to measured before level. Two groups of every heartbeat quantity (SV) in gasless changes after are not significant (P > 0.05). Two groups of cardiac output (CO) and cardiac index (CI) were measured after in significantly increased (P < 0.05), HP group more remarkable, after releasing air 5min, two group restore somewhat but still significantly higher measured before level (P < 0.05).
Conclusions:The CO_2 gasless pressure to achieve 10mmHg when after laparoscopic renal vesssed can do, but due to the low pressure gasless, the operation process operative field of exposure, intraoperatie bleeding problems such as the control has the certain difficulty, cause operation time is longer, gasless prolonged, the operation is relatively difficult, But when gasless pressure to achieve 15mmHg, due to gasless pressure big, to the body, especially significant respiratory system, cause operative complication, and thus maintain gasless pressure in 10 ~ 15mmHg between, intraoperative physiological indexes, more stable operation and patients recovery is better.
引文
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