摘要
目的观察轻度过度通气下施行ＣＯ２气腹对呼吸和动脉血气的影响。方法行择期腹腔镜胆囊切除术（ＬＣ ）病人 术前快速诱导麻醉，气管内插管后行机械通气，吸入Ｎ２Ｏ、持续静脉输注异丙酚维持全麻，硬膜外间断给药。分别在诱导 前 ５ ｍｉｎ、气腹前 ｌｍｉｎ和气腹后 ５、１０、２０、３０、４０、５０、６０ ｍｉｎ及放气后 ５ ｍｉｎ记录各监测值，同时采桡动脉血作血气分 析。结果气腹开始后２０～６０ ｍｉｎ，呼气末ＣＯ２分压（ＰＥＴＣＯ２）和ＣＯ２排出量（ＶＣＯ２）较气腹前显著升高。气腹开始后，ｐＨ 值逐渐降低，３０ ｍｉｎ时较诱导前显著降低；ＰａＣＯ２逐渐升高，６０ ｍｉｎ时较诱导前显著升高，但ＰＥＴＣＯ２、ＶＣＯ２、ＰａＣＯ２及 ｐＨ的变化均在正常范围。在气腹初期，气道压（ＰＡＷ）较气腹前显著升高，而呼气分钟通气量（ＭＶＥ）较气腹前明显降 低。结论采用异丙酚静脉全麻复合硬膜外麻醉及气腹前适当过度通气的呼吸管理方式在ＬＣ中是切实可行的。
Objective To investigate the effects of intraperitoneal CO2 insufflation on respiration and arterial blood gas by adequate excessive ventilation before CO2 insufflation. Methods Intratracheal intubation was performed after rapid induction of anesthesia, followed by mechanical ventilation to maintain the tidal volume at 10 ml/kg·b.w., and respiration the at 12 min-1). N2O inspiration and continuous intravenous infusion of propofol (2 mg·kg-1. h-l) by intermittent epidural administration were performed to maintain anesthesia. Data of the hemodynamics, arterial blood gas and ventilation was collected at 5 min preinduc-tion, lmin preinsufflatioqn, and 5, 10, 20, 30, 40, 50, 60 after the start of CO2 insuffiation as well as at 5 min after CO2 elimination. Results End-tidal CO2 (PETCO2 and CO2 production (VCO2) markedly increased during the period of 20 to 60 min after CO2 insufflation, compared with that before CO2 insufflation. pH value gradually decreased while PaCO2 increased after CO2 insufflation which became evident at 30 min and 60 min respectively. The changes of PETCO2, VCO2, pH and PaCO2 were in normal range. Airway pressure (PAW) remarkably rose and minute ventilatory effort (MVE) markedly decreased during early CO2 insufflation. Cojnculsions Intravenuos anesthesia combined with propofol, epidural anesthesia and adequate excessive ventilation is clinically applicable.
出处
《第一军医大学学报》
CSCD
北大核心
2001年第2期121-122,125,共3页
Journal of First Military Medical University
