摘要
目的观察异丙酚静脉全麻复合硬膜外腔阻滞麻醉期间CO2气腹对机体血流动力学和氧耗及CO2排出量的影响。方法择期行腹腔镜胆囊切除术(LC)患者24例,快速诱导气管插管后行机械通气,持续静脉输注异丙酚及吸入氧化亚氮维持麻醉,并间断硬膜外腔给药。分别在诱导前、气腹前1min和气腹后5、10、20、30、40、50、60min及放气后5min记录血流动力学和呼吸功能各项参数。结果在气腹前1min,平均动脉压(MAP)、心率(HR)、呼气末CO2分压(PETCO2)、氧耗量(VO2)、二氧化碳排出量(VCO2)较诱导前显著降低(P<0.01)。气腹期间及放气后5min,MAP及HR较稳定,波动幅度不大。PETCO2在气腹后10min时较气腹前显著增加(P<0.01),以后继续升高。VO2和VCO2在气腹开始后逐渐升高,VO2在气腹后10min时显著高于气腹前水平(P<0.01),VCO2在气腹后20min时较气腹前显著增加(P<0.05),以后VO2继续升高,而VCO2升幅较小。结论在LC手术期间,应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可以减轻CO2气腹对呼吸和循环系统的影响。
Objective To investigatethe effectsof intraperitonealCO 2 insufflationon the hemodynamics,oxygen consumption(VO 2 )andcarbondioxideproduction(VCO 2 )duringintravenousanesthesiawithpropofolin combinationwith epiduralblock.Methods Intratrachealintubationwas performedafterrapidinductionof anesthesiaand mechanical ventilationwasgiven.Maintenanceof anesthesiawasachievedusingcontinousintravenouspropofolinfusion(2mg·kg -1 ·h -1 ),N 2 O inhalationandintermittentepiduraladministration.Indicesof hemodynamicsandrespiratoryfunctionwerecollected5minbeforeinduction,1minbeforeCO 2 insufflation,and5,10,20,30,40,50,60minafterthestartof insufflationand5min aftertheterminationof insufflation.Results Themeanarterialpressure(MAP),heartrate(HR),end-tidalPCO 2 (P ET CO 2 ),VO 2 andVCO 2 1minbeforeinsufflationweremarkedlyreduced(P<0.01),comparedwiththoserecordedbeforeinduction.MAP andHRdidnotundergoanyconspicuouschangesduringCO 2 insufflationand5minafterinsufflationtermination.Compared withthat1minbeforeinsufflation,P ET CO 2 was significantlyincreased20minafterthestartof insufflation(P<0.01),and subsequentlycarriedon theincreasethoughof a lesserscale.VO 2 andVCO 2 graduallyroseafterthestartof insufflation,and VO 2 presenteda significantlyelevation(P<0.01)10minaftertheinsufflationwhileVCO 2 didnotshowthismarkedincrease(P<0.05)till20minaftertheinsufflationincomparisonwiththelevelsbeforeinsufflation.Subsequently,VO 2 continuedto riseandVCO 2 alsoretainedtheincreasebutof smallermagnitude.Conclusion Intravenouspropofolanesthesiacombined withepiduralblockassistedby well-managedexcessiveventilationbeforeinsufflationcanalleviatetheadverseeffectsof CO 2 insufflationon respiratoryandcirculatorysystems.
出处
《第一军医大学学报》
CSCD
北大核心
2002年第2期166-167,共2页
Journal of First Military Medical University
关键词
气腹
二氧化碳
异丙酚
硬膜外麻醉
氧消耗
pneumoperitonium
carbondioxide
propofol
anesthesia,epidural
oxygenconsumption
