摘要
目的:探讨七氟醚麻醉下CO2气腹对胃黏膜pH的影响。方法:20例妇科择期腹腔镜手术者静注枸橼酸芬太尼2～4μg/kg、得普利麻2 mg/kg、罗库溴胺1 mg/kg后,行气管插管机械通气。吸入1.0%～1.5%最低肺泡浓度七氟醚,静注阿曲库胺(0.5～1 mg.kg-1.h-1);术中行1.6 kPa CO2气腹。记录患者气腹前(T1)、气腹后15 min(T2)、30 min(T3)、60 min(T4)、放弃气腹后15 min(T5)HR、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、呼吸末CO2分压(PetCO2),同时用胃张力监测仪监测患者胃肠黏膜CO2分压(PgCO2),胃黏膜-动脉血CO2分压差(Pg-aCO2),胃黏膜-呼吸末CO2分压差(Pg-etCO2)及胃黏膜pH值(pHi),行动脉血气分析。结果:本组T2～5的PgCO2、Pg-aCO2、Pg-etCO2均较T1明显升高(P<0.05),pHi均较T1明显降低(P<0.05),上述指标在T5均未回到T1水平(P<0.05)。且T2、T3与T4比,上述各项指标有统计学意义(P<0.05),T5与T3比无统计学意义,T5与T4比有统计学意义(P<0.05)。结论:七氟醚麻醉下行压力1.6 kPa CO2气腹妇科腹腔镜手术可见pHi降低现象,随手术时间延长趋向严重,且于T5后仍未恢复到术前水平。
Objective： To study the influence of CO2 pneumoperitonaum on pH value of gastric mucosa in sevoflurane aneasthesia. Methods： The patients were anesthetized by fentanil 2-4μg/kg, propofol 2 mg/kg, vecumnium 1 mg/kg, induced trachea cannula. All the patients were given 1.0%-1.5% sevoflurane inhalation, and injected with atracurium besylate 0.5 -1 mg· kg^-1· h^-1in vein. Surgery underwent 1.6 kPa CO2 pneumoperitoneum. The heart rate（HR）, mean arterial pressure（MAP）, pulse oxygen satumtion（Sp2）, end-tidal carbon dioxide pressure（PetCO2）were recorded before pneumoperitoneum（T1）, 15 minutes after pneumoperitoneum（T2）, 30 minutes after pneumoperltoneum（T3）, 60 minutes after pneumoperitoneumand（T4）, and 15 minutes after desuftlation（T5）and the gastric intramucosal carbon dioxide pressure（PgCO2）, gastric intramucosal-arterial carbon dioxide pressure（Pg-aCO2）, and gastric intramueosal- end-tidal carbon dioxide pressure（Pg-etCO2）、 gastric intramucosal pH（pHi）were assessed by tonometry. The arterial blood gas was analyzed. Results： In all the patients, PgCO2, Pg-aCO2, and Pg-etCO2 at T2~5 were significantly higher than those at TI（P 〈 0.05）, pHi was significantly lower than that at T1. The parameters at T5 did not retum to the level at T1（P 〈 0.05）. There was no significant difference between T3 and T5.T4 was significandy higher than at T5（ P 〈 0.05）. Conclusion： In surgery underwent 1.6 kPa CO2 pneumoperitoneum, sevoflurane can cause the reduction of pHi, and the parameters can not be restored to the preoperative level after TS.
出处
《汕头大学医学院学报》
2010年第3期164-167,共4页
Journal of Shantou University Medical College
关键词
七氟醚
CO2气腹
胃黏膜PH
sevoflurane, carbox dioxide pneumoperitoneum, gastric mucosa pH
