国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2015年
5期
404-407
,共4页
腹膜后腔镜%二氧化碳气腹%皮下气肿
腹膜後腔鏡%二氧化碳氣腹%皮下氣腫
복막후강경%이양화탄기복%피하기종
Retroperitoneoscopy%Carbon dioxide pneumoperitoneum%Subcutaneous emphysema
目的 探讨腹膜后腔镜手术中二氧化碳气腹并发皮下气肿对患者血流动力学、血气及麻醉苏醒的影响.方法 回顾分析87例择期行腹膜后腔镜肾癌根治手术患者,依据皮下气肿严重程度把患者分为3组:无皮下气肿患者组(A组,66例)、1级和2级的轻度皮下气肿患者组(B组,15例)、3级的重度皮下气肿患者组(C组,6例).B组和C组发生皮下气肿后行过度通气.分别于气腹前(T0)、气腹后30 min(T1)、气腹后60 min(T2)、气腹后90 min(T3)及手术结束时(T4)、拔管时、拔管后30 min监测患者血气、呼气末二氧化碳分压(end-tidal carbon dioxide partial pressure,PETO2)、心率(heart rate,HR)、平均动脉压(mean artery pressure,MAP),同时观察麻醉苏醒情况.结果 C组在T2～T4时间点的动脉血二氧化碳分压(partial pressureof carbon dioxide in artery,PaCO2)、PETCO2、HR、MAP值均显著高于A组(P＜0.05),pH值均显著低于A组(P＜0.05).C组患者术后呼唤睁眼时间[(16±6) min]显著长于A组[(11±3) min](P＜0.05),定向力恢复时间[(30±7) min]显著长于A组[(23±6) min](P＜0.05).C组拔管时PaCO2[(52±7) mmHg(1 mmHg=0.133 kPa)]显著高于A组[(45±4) mmHg](P＜0.05),拔管后30 min的PaCO2[(48±7)mmHg]显著高于A组[(39±4) mmHg(P＜0.05)].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,患者血压升高、HR加快,苏醒时间延长.
目的 探討腹膜後腔鏡手術中二氧化碳氣腹併髮皮下氣腫對患者血流動力學、血氣及痳醉囌醒的影響.方法 迴顧分析87例擇期行腹膜後腔鏡腎癌根治手術患者,依據皮下氣腫嚴重程度把患者分為3組:無皮下氣腫患者組(A組,66例)、1級和2級的輕度皮下氣腫患者組(B組,15例)、3級的重度皮下氣腫患者組(C組,6例).B組和C組髮生皮下氣腫後行過度通氣.分彆于氣腹前(T0)、氣腹後30 min(T1)、氣腹後60 min(T2)、氣腹後90 min(T3)及手術結束時(T4)、拔管時、拔管後30 min鑑測患者血氣、呼氣末二氧化碳分壓(end-tidal carbon dioxide partial pressure,PETO2)、心率(heart rate,HR)、平均動脈壓(mean artery pressure,MAP),同時觀察痳醉囌醒情況.結果 C組在T2～T4時間點的動脈血二氧化碳分壓(partial pressureof carbon dioxide in artery,PaCO2)、PETCO2、HR、MAP值均顯著高于A組(P＜0.05),pH值均顯著低于A組(P＜0.05).C組患者術後呼喚睜眼時間[(16±6) min]顯著長于A組[(11±3) min](P＜0.05),定嚮力恢複時間[(30±7) min]顯著長于A組[(23±6) min](P＜0.05).C組拔管時PaCO2[(52±7) mmHg(1 mmHg=0.133 kPa)]顯著高于A組[(45±4) mmHg](P＜0.05),拔管後30 min的PaCO2[(48±7)mmHg]顯著高于A組[(39±4) mmHg(P＜0.05)].結論 後腹腔鏡手術併髮重度皮下氣腫導緻患者高碳痠血癥,患者血壓升高、HR加快,囌醒時間延長.
목적 탐토복막후강경수술중이양화탄기복병발피하기종대환자혈류동역학、혈기급마취소성적영향.방법 회고분석87례택기행복막후강경신암근치수술환자,의거피하기종엄중정도파환자분위3조:무피하기종환자조(A조,66례)、1급화2급적경도피하기종환자조(B조,15례)、3급적중도피하기종환자조(C조,6례).B조화C조발생피하기종후행과도통기.분별우기복전(T0)、기복후30 min(T1)、기복후60 min(T2)、기복후90 min(T3)급수술결속시(T4)、발관시、발관후30 min감측환자혈기、호기말이양화탄분압(end-tidal carbon dioxide partial pressure,PETO2)、심솔(heart rate,HR)、평균동맥압(mean artery pressure,MAP),동시관찰마취소성정황.결과 C조재T2～T4시간점적동맥혈이양화탄분압(partial pressureof carbon dioxide in artery,PaCO2)、PETCO2、HR、MAP치균현저고우A조(P＜0.05),pH치균현저저우A조(P＜0.05).C조환자술후호환정안시간[(16±6) min]현저장우A조[(11±3) min](P＜0.05),정향력회복시간[(30±7) min]현저장우A조[(23±6) min](P＜0.05).C조발관시PaCO2[(52±7) mmHg(1 mmHg=0.133 kPa)]현저고우A조[(45±4) mmHg](P＜0.05),발관후30 min적PaCO2[(48±7)mmHg]현저고우A조[(39±4) mmHg(P＜0.05)].결론 후복강경수술병발중도피하기종도치환자고탄산혈증,환자혈압승고、HR가쾌,소성시간연장.
Objective To explore the effect of subcutaneous emphysema due to retroperitoneal laparoscopic carbon dioxide pneumoperitoneum on hemodynamic,arterial blood gas,and awakening time in patients undergoing nephrectomy surgery.Methods Eighty-seven patients with kidney cancer scheduled for radical nephrectomy surgery were retrospectively studied.Patients were divided into three groups according to the severity of subcutaneous emphysema:patients without subcutaneous emphysema group (group A,n=66),patients with grade 1 or 2 subcutaneous emphysema group (group B,n=15),and patients with severe subcutaneous emphysema in grade 3 group (group C,n=6).Group B and group C were treated by excessive ventilation.At the time before pneumoperitoneum (T0),30 (T1),60(T2),90 min(T3) after CO2 insufflation,the end of operation(T4),and 30 min after tracheal extubation,arterial blood gas analysis,end-tidal carbon dioxide partial pressure(PETCO2),heart rate(HR),and mean artery pressure (MAP) were recorded.The time of awake were also observed.Results At T2-T4 time point,partial pressure of carbon dioxide in artery (PaCO2),PETCO2,HR,MAP in group C were significantly higher than those in group A (P＜0.05).At T2-T4 time point the pH in group C were significantly lower than that of group A(P＜0.05).The time of call can open eyes after surgery in group C [(16±6) min] were significantly longer than that of group A [(11 ±3) min](P＜0.05).The time of orientation recovery in group C [(30±7) min] were significantly longer than that of group A [(23±6) min](P＜0.05).At extubation and 30 min after extubation,PaCO2 in group C [(52±7),(48±7) mmHg(1 mmHg=0.133 kPa)] were significantly higher than that of group A [(45±4),(39±4) mmHg] (P＜0.05).Conclusions Severe subcutaneous emphysema may lead to hypercapnia,elevate blood pressure and HR,and postpone the awake time.
