CAJ | 학술논문

目的：探讨不同气腹压力对应用达芬奇机器人行腹部手术患者术中呼吸、术后并发症的影响。方法将2013年6～9月行机器人手术的90例患者随机分为三组，实验组1：气腹压力10 mmHg ；实验组2：气腹压力12 mmHg ；实验组3：气腹压力14 mmHg。观察三组患者在气腹前、气腹后即刻、气腹后0．5 h、1 h、1．5 h、2 h、4 h、6 h不同时间点的潮气末CO2（ETCO2）、气道压峰值（PEAK）的数值变化及并发症。结果三组患者ETCO2在气腹后均呈现逐渐增加趋势，实验1组ETCO2在气腹后增加幅度最小，差异有统计学意义（P＜0．05）；三组患者气道峰压在气腹后增加幅度较大，但差异无统计学意义（P＞0．05）；三组患者在高碳酸血症、苏醒时间方面差异均有统计学意义（P＜0．05）。结论在保证安全操作和不影响手术视野的情况下，调低CO2气腹压，可减少对病人呼吸系统的影响，降低ETCO2和气道峰压，减少并发症的发生。
목적：탐토불동기복압력대응용체분기궤기인행복부수술환자술중호흡、술후병발증적영향。방법장2013년6～9월행궤기인수술적90례환자수궤분위삼조，실험조1：기복압력10 mmHg ；실험조2：기복압력12 mmHg ；실험조3：기복압력14 mmHg。관찰삼조환자재기복전、기복후즉각、기복후0．5 h、1 h、1．5 h、2 h、4 h、6 h불동시간점적조기말CO2（ETCO2）、기도압봉치（PEAK）적수치변화급병발증。결과삼조환자ETCO2재기복후균정현축점증가추세，실험1조ETCO2재기복후증가폭도최소，차이유통계학의의（P＜0．05）；삼조환자기도봉압재기복후증가폭도교대，단차이무통계학의의（P＞0．05）；삼조환자재고탄산혈증、소성시간방면차이균유통계학의의（P＜0．05）。결론재보증안전조작화불영향수술시야적정황하，조저CO2기복압，가감소대병인호흡계통적영향，강저ETCO2화기도봉압，감소병발증적발생。
Objective To study the effect of different pneumoperitoneum on patients during davinci robot‐assisted surgery .Method 90 patients with robot‐assisted surgery were randomly divided into groups1 ,group 2 and group 3 . Pneumoperitoneum was established respectively at 10 mmHg (group 1) ,12 mmHg(group 2) and 14mmHg (group 3) .The change of end‐tidal CO2 (ETCO2 ) ,Peak Airway Pressure (PEAK) and the complication before insufflation at 0 min ,30 min ,4 hours and 6 hours after insufflation was measured and compared .Result Compared with the data before insufflation ,ETCO2 of three groups all increased significantly after insufflation ,but group 1 increased signifi‐cantly lower than thzt of group 1 and group 2 (P<0 .05) .Compared with the data before insufflation ,PEAK of three groups increased significantly after insufflation ,but there was no significantly different in three groups each other(P>0 .05) .Hypercapnia ventilation ,awake time were significantly different in three groups (P<0 .05) .Con‐clusion Reducing CO2 pressure without effecting surgery could decrease the effect on respiratory system ,reduce ET‐CO2 ,PEAK and occurrence of complications during davinci robot‐assisted surgery .