全麻腹腔镜子宫切除术低水平PEEP对PaCO2和PET CO2及两者相关性影响的临床研究

摘要

Objective To investigate the effects of low positive end expiratory pressure ( PEEP) on the partial pres-sure of carbon dioxide (PaCO2) and end-tidal CO2 pressure (PETCO2) under general anesthesia in laparoscopic hyster-ectomy.Methods A total of 40 ASA I to II patients receiving laparoscopic hysterectomy were randomly divided into Groups A and B (n=20).All patients underwent intravenous anesthesia through endotracheal intubation, with the same doses for anesthetic induction and maintenance.Then, mechanical ventilation was provided, using the same respiratory parameters.For CO2 pneumoperitoneum, the pressure was set at 12 mmHg.Meanwhile, 5 cmH2 O PEEP was added in Group A, but the ventilation mode and parameters remain the same in Group B.Then, their PaCO2 , PET CO2 , mean arte-rial pressure ( MAP) , and heart rate ( HR) were recorded before pneumoperitoneum ( T0 ) , 30 min after pneumoperitone-um time ( T1 ) and 60 min after pneumoperitoneum ( T2 ) .Results Both groups presented remarkable increases in PaCO2, PETCO2 and Pa-ETCO2 at T1 and T2, rather than at T0(P<0.05), where the changes were more obvious in Group B than in Group A ( P<0.05) .There was no statistical difference in MAP and HR between both groups before and after pneumoperitoneum.A positive relationship was found between PaCO2 and PET CO2 of these groups before and af-ter pneumoperitoneum, where at T1 and T2 a better relationship was found in Group A than Group B.Conclusions Low PEEP under general anesthesia in laparoscopic hysterectomy can reduce the effects of CO2 pneumoperitoneum on PaCO2 and PET CO2 , and enhance the relationship between PaCO2 and PET CO2 .%目的：研究腹腔镜子宫切除术全麻下应用低水平PEEP通气模式，对动脉血二氧化碳分压（ PaCO2）和呼气末二氧化碳分压（ PET CO2）及其两者相关性的影响。方法 ASAⅠ～Ⅱ级腹腔镜下行子宫切除手术患者40例，随机分为A、B两组，每组各20例。采用气管插管全凭静脉麻醉，麻醉诱导及维持用药相同，气管插管后机械呼吸，呼吸参数相同。 CO2气腹后，气腹压力设置为12 mmHg，A组加用5 cmH2 O的PEEP ，B组通气模式和参数不变。观察记录气腹前时点（ T0）、气腹后30 min时点（ T1）及气腹后60 min时点（ T2）的PaCO2、 PET CO2、动脉－呼气末CO2分压差（Pa－ETCO2）及平均动脉压（MAP）、心率（HR）。结果 T1、T2时点，各组的PaCO2、PETCO2及Pa－ETCO2均较T0时点明显增大（P＜0．05）。 T1、T2时点，B组的PaCO2、PETCO2及 Pa－ETCO2均明显大于A组（P＜0．05）。气腹前后各组MAP、HR差异无统计学意义。气腹前后2组在PaCO2与PET CO2之间均呈正性相关，其中T1、T2时点，A组的相关系数大于B组。结论全麻腹腔镜子宫切除术低水平PEEP有助于减小CO2气腹对PaCO2和PET CO2的影响，提高PaCO2与PET CO2两者的相关性。