摘要
目的探讨二氧化碳(CO_(2))人工气腹不同气腹压力对腹腔镜胃部分切除术患者中心静脉压(CVP)的影响。方法选取2019年5月—2020年12月江苏省淮安市淮阴医院患胃部肿瘤并择期全身麻醉下行腹腔镜下胃部分切除的40例患者作为研究对象,根据随机数字表法将其分为A、B组,每组各20例。A组患者的人工气腹压力设置为10 mmHg,B组患者的人工气腹压力设置为15 mmHg。比较两组患者气腹前(T_(0))、气腹后30 min(T_(1))、气腹后60 min(T_(2))及气腹终止后10 min(T_(3))的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_(2))、CVP、平均气道压力(P_(mean))、呼气末二氧化碳分压(P_(ET)CO_(2))、动脉二氧化碳分压(PaCO_(2))。结果两组患者不同时间点的MAP、HR、SpO_(2)比较,差异均无统计学意义(P>0.05);两组患者T_(1)、T_(2)时的CVP、P_(mean)、PaCO_(2)、P_(ET)CO_(2)均高于T_(0)时,差异有统计学意义(P<0.05);B组患者T_(1)、T_(2)时的CVP、P_(mean)、PaCO_(2)、P_(ET)CO_(2)均高于A组,差异有统计学意义(P<0.05)。结论不同气腹压力对CVP的影响不同,压力高则使CVP升高。需要行控制性低CVP的手术,宜选用较低的气腹压力,有利于降低CVP,此时的CVP不再用作循环功能的监测,而作为协助降低CVP辅助手段。
Objective To investigate the effect of carbon dioxide(CO_(2))artificial pneumoperitoneum with different pneumoperitoneum pressure on central venous pressure in patients undergoing laparoscopic partial gastrectomy.Methods A total of 40 patients with gastric tumors undergoing selective laparoscopic partial gastrectomy under general anesthesia in Huaiyin Hospital of Huai′an City,Jiangsu Province from May 2019 to December 2020 were selected as the study subjects.According to the random number table method,they were divided into group A and group B,with 20 patients in each group.The pneumoperitoneum pressure was set at 10 mmHg in group A and 15 mmHg in group B.The mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO_(2)),central venous pressure(CVP),mean airway pressure(P_(mean)),end-tidal pressure of carbon dioxide(P_(ET)CO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))before pneumoperitoneum(T_(0)),30 min after pneumoperitoneum(T_(1)),60 min after pneumoperitoneum(T_(2))and 10 min after pneumoperitoneum termination(T_(3))were compared between the two groups.Results There were no statistically significant differences in MAP,HR and SpO_(2) between the two groups at different time points(P>0.05).CVP,P_(mean),PaCO_(2) and P_(ET)CO_(2) at T_(1) and T_(2) were higher than those at T_(0),and the differences were statistically significant(P<0.05).CVP,P_(mean),PaCO_(2) and P_(ET)CO_(2) in group B at T_(1) and T_(2) were higher than those in group A,and the differences were statistically significant(P<0.05).Conclusion The effect of different pneumoperitoneal pressures on CVP differ,CVP increasing with high pressures.Surgery that requires a controlled low CVP,with an appropriate lower pneumoperitoneum pressure,is beneficial in lowering the CVP,at which point the CVP is no longer used as a monitor of circulatory function but rather as an adjunct to assist in lowering the CVP.
作者
叶炜
陈金红
姚盛来
YE Wei;CHEN Jin-hong;YAO Sheng-lai(Department of Anesthesiology,Huaiyin People′s Hospital of Huai′an City,Jiangsu Province,Huai′an 223300,China;Department of Anesthesiology,Huaiyin Hospital of Huai′an City,Jiangsu Province,Huai′an 223300,China)
出处
《中国当代医药》
CAS
2021年第25期124-127,共4页
China Modern Medicine
关键词
气腹压力
中心静脉压
腹腔镜胃切除术
Pneumoperitoneum pressure
Central venous pressure
Laparoscopic gastrectomy
