CAJ | 학술논문

目的：观察腹腔内持续热灌注（continuous hyperthermic peritoneal perfusion, CHPP）对腹腔假黏液瘤手术患者呼吸力学、血流动力学及生化指标的影响。方法 ASAⅠ～Ⅲ级择期腹腔假黏液瘤手术患者20例，吻合口缝合完毕后进行CHPP。手术和热化疗过程中进行呼吸力学、血流动力学及生化代谢监测。结果 CHPP过程中颅脑温（鼻咽温）增高明显（P＜0.05），CHPP后30 min颅脑温依然显著增高，气道峰压（Ppeak）增高，顺应性（Compl）降低（P＜0.05），CHPP结束后恢复正常；PCO2在CHPP 15 min后开始显著增加；心率（HR）显著增快；平均动脉压（MAP）显著下降，CHPP结束后30 min恢复到热灌注前水平；血糖快速升高，CHPP开始前即需要应用胰岛素控制血糖，随CHPP时间的延长，胰岛素的用量增加，CHPP结束后血糖水平开始下降（P＜0.05）；CHPP期间血浆钾、钠离子浓度下降（P＜0.05）；pH、BE、HCO3-显著下降（P＜0.01）。 CHPP过程中HR加快与体温上升有良好的相关性（r=0.976，P＜0.05）。结论 CHPP主要引起体温上升、血糖升高及继发的一系列血流动力学与生化变化，对机体内稳态产生较大的影响。术中需有较好的监测，及时预防与处理，麻醉管理还是安全可控的。
목적：관찰복강내지속열관주（continuous hyperthermic peritoneal perfusion, CHPP）대복강가점액류수술환자호흡역학、혈류동역학급생화지표적영향。방법 ASAⅠ～Ⅲ급택기복강가점액류수술환자20례，문합구봉합완필후진행CHPP。수술화열화료과정중진행호흡역학、혈류동역학급생화대사감측。결과 CHPP과정중로뇌온（비인온）증고명현（P＜0.05），CHPP후30 min로뇌온의연현저증고，기도봉압（Ppeak）증고，순응성（Compl）강저（P＜0.05），CHPP결속후회복정상；PCO2재CHPP 15 min후개시현저증가；심솔（HR）현저증쾌；평균동맥압（MAP）현저하강，CHPP결속후30 min회복도열관주전수평；혈당쾌속승고，CHPP개시전즉수요응용이도소공제혈당，수CHPP시간적연장，이도소적용량증가，CHPP결속후혈당수평개시하강（P＜0.05）；CHPP기간혈장갑、납리자농도하강（P＜0.05）；pH、BE、HCO3-현저하강（P＜0.01）。 CHPP과정중HR가쾌여체온상승유량호적상관성（r=0.976，P＜0.05）。결론 CHPP주요인기체온상승、혈당승고급계발적일계렬혈류동역학여생화변화，대궤체내은태산생교대적영향。술중수유교호적감측，급시예방여처리，마취관리환시안전가공적。
Objective To evaluate the effects of continuous hyperthermic peritoneal perfusion (CHPP) on respirato-ry, cardiovascular system and biochemical parameters. Methods Twenty ASAⅠ~Ⅲ patients underwent cytoreductive surgery followed by CHPP were involved. The respiratory function, hemodynamics and biochemical parameters were recorded during the whole procedure. Results The nose temperature (T) increased significantly during CHPP. Respiratory function changed markedly, and PCO2 raise significantly 15 min after CHPP. Heart rate increased during CHPP and re-turned to (92.8 ±12.6) bpm (P< 0.05) after CHPP. During CHPP, the mean artery pressure decreased significantly (P<0.05), meanwhile, CVP also increased significantly, which returned to normal when CHPP was ended. For biochemi-cal metabolism, the blood glucose level changed significantly after CHPP, so it should be necessary to use insulin to con-trol blood glucose level before CHPP. Along with the CHPP, the dosage of insulin increased. After CHPP, the levels of blood glucose began to fall, during CHPP, plasma potassium and sodium ion concentration decreased, pH, BE and HCO 3-also decreased significantly. During CHPP, the increase of HR had good relationship with the change of blood temperature (r=0.976, P<0.05). Conclusion During CHPP, the hemodynamic and biochemical parameters change significantly. It is necessary to monitor and manage during anesthesia to ensure the safety of patients.