CAJ | 학술논문

目的：探讨后腹腔镜手术并发皮下气肿对全身麻醉患者血气及苏醒的影响。方法依据皮下气肿严重程度把200例择期行后腹腔镜手术患者分为A、B、C组，其中A组为123例无皮下气肿患者；B组为54例1级和2级的轻度皮下气肿患者；C组为23例3级的重度皮下气肿患者。对B组和C组行过度通气。分别于气腹前、气腹后30、60、90 min及手术结束时、拔管时、拔管后30 min血气分析，同时观察苏醒情况。结果 C组在T2～T4时间点的PaCO2、PET CO2值均显著高于A组（P＜0.05）；C组在T2～T4时间点的pH值均显著低于A组（P＜0.05）；C组患者麻醉苏醒时间显著长于A组（P＜0.05）。C组拔管时PaCO2、拔管后30 min的PaCO2显著高于A组。结论后腹腔镜手术并发重度皮下气肿导致患者高碳酸血症，苏醒时间延长。
목적：탐토후복강경수술병발피하기종대전신마취환자혈기급소성적영향。방법의거피하기종엄중정도파200례택기행후복강경수술환자분위A、B、C조，기중A조위123례무피하기종환자；B조위54례1급화2급적경도피하기종환자；C조위23례3급적중도피하기종환자。대B조화C조행과도통기。분별우기복전、기복후30、60、90 min급수술결속시、발관시、발관후30 min혈기분석，동시관찰소성정황。결과 C조재T2～T4시간점적PaCO2、PET CO2치균현저고우A조（P＜0.05）；C조재T2～T4시간점적pH치균현저저우A조（P＜0.05）；C조환자마취소성시간현저장우A조（P＜0.05）。C조발관시PaCO2、발관후30 min적PaCO2현저고우A조。결론후복강경수술병발중도피하기종도치환자고탄산혈증，소성시간연장。
Objective To explore the influence of retroperitoneoscopic surgery complicated with subcutaneous emphysema on results of arterial blood gas analysis and awakening time of patients under general anesthesia.Methods Two hundred patients who scheduled for retroperitoneoscopy were divided into three groups according to severity of subcutaneous emphysema:group A of 123 patients with no subcuta-neous emphysema;group B of 54 patients with mild subcutaneous emphysema of grade I or II;group C of 23 patients with severe subcutane-ous emphysema of grade Ⅲ.Patients in group B and group C were treated with excessive ventilation.At the time before pneumoperitoneum (T0)and 30 min (T1),60 min (T2),90 min (T3)after CO2 insufflation,and at the time of operation being finished (T4),tracheal extu-bation and 30 min thereafter,the arterial blood gas analysis was conducted and recorded.The awakening situation was observed at the same time point.Results At the T2~T4 time point,the PaCO2 and PETCO2 values of patients in group C were significantly higher than those in group A (P<0.05 ),but the pH values in group C were significantly lower than those in group A (P<0.05 ).The awakening time of pa-tients in group C was significantly longer than that in group A (P<0.05 ).The PaCO2 values in group C at the time of tracheal extubation and 30 min thereafter were also significantly higher than those in group A.Conclusion Retroperitoneoscopic surgery complicated with severe subcutaneous emphysema would lead to hypercapnia and delayed resuscitation in patients under general anesthesia.