腹腔镜胃癌根治术二氧化碳气腹对 PaCO2及 PETCO2的影响

摘要

目的：探讨腹腔镜胃癌根治术二氧化碳（CO2）气腹对动脉血二氧化碳分压（PaCO2）及呼气末二氧化碳分压（PETCO2）的影响。方法择期全身麻醉下行腹腔镜胃癌根治术患者60例，分别在气腹开始前5 min（T0）、建立气腹后15 min（T1）、30 min（T2）、45 min（T3）及停气腹后5 min（T4）时采集动脉血测定 PaCO2及 PETCO2，计算PaCO2与 PETCO2的差值（Pa-ETCO2）和 Pa-ETCO2与 PaCO2的比值（Pa-ETCO2／PaCO2）。结果60例患者手术时间为175～285（227．8±42．6）min，气腹时间为121～158（136．3±11．8）min。T0时 PaCO2、PETCO2、Pa-ET-CO2和 Pa-ETCO2／PaCO2变化与 T1比较差异均无统计学意义（均 P ＞0．05）。T2、T3时患者 PaCO2、PETCO2、Pa-ETCO2和 Pa-ETCO2／PaCO2明显高于 T0和 T1（均 P ＜0．05）。T4时患者的 PaCO2和 PETCO2较 T2、T3明显降低，Pa-ETCO2和 Pa-ETCO2／PaCO2较 T2、T3明显升高（均 P ＜0．05）。结论腹腔镜胃癌根治术中 PETCO2不能准确反映 PaCO2，且两者差异随 CO2气腹时间的延长而扩大。%Objective To investigate the effects of carbon dioxide pneumoperitoneum on arteri-al partial pressure of carbon dioxide(PaCO2 )and partial pressure of end-tidal carbon dioxide (PETCO2 )during laparoscopic-assisted radical gastrectomy for gastric cancer.Methods Arterial blood samples were obtained 5 minutes before the creation of pneumoperitoneum(T0 ),15(T1 ),30 (T2 )and 45 minutes(T3 )after the creation of pneumoperitoneum,and 5 minutes after the end of pneumoperitoneum(T4 )for the determination of PaCO2 and PETCO2 in 60 patients undergoing e-lective laparoscopic-assisted radical gastrectomy for gastric cancer.The PaCO2-PETCO2 (Pa-ET-CO2 )difference and Pa-ETCO2/PaCO2 ratio were calculated.Results The operation time was 175-285(227.8 ± 42.6)minutes.The pneumoperitoneum time was 121-158(136.3 ± 11.8)mi-nutes.There were no differences in PaCO2 ,PETCO2 ,Pa-ETCO2 difference and Pa-ETCO2/PaCO2 ratio between T0 and T1 (P > 0.05).Compared with T0 and T1 ,PaCO2 ,PETCO2 ,Pa-ETCO2 difference and Pa-ETCO2/PaCO2 ratio increased at T2 and T3 (P <0.05).Compared with T2 and T3 ,PaCO2 and PETCO2 decreased but Pa-ETCO2 difference and Pa-ETCO2/PaCO2 ratio increased at T4 (P <0.05).Conclusion PETCO2 can not accurately reflect the PaCO2 during laparoscopic-assisted radical gastrectomy for gastric cancer,and Pa-ETCO2 difference increases with the exten-sion of pneumoperitoneum time.