摘要
本文观察了１２例ＡＳＡ１级胆囊结石病人腹腔镜胆囊切除术中的肺功能变化。年龄为４０．７±９．４岁，体重６１．４±９．４ｋｇ。Ｍｉｄａｚｏｌａｍ－Ｆｅｎｔａｎｙｌ－Ｉｓｏｆｌｕｒａｎｅ－Ｔｒａｃｒｉｕｍ维持麻醉，控制呼吸，间歇正压通气。连续监测吸气气道峰压（ＰＩＰ），动态肺应性（ＬＣ），ＰＥＣＯ２，ＥＫＧ，ＮＩＢＰ和ＳｐＯ２。结果：体位改变对ＰＩＰ和ＰＥＣＯ２无明显影响（Ｐ＞０．０５），却使ＬＣ下降９．７％（Ｐ＞０．０５）。腹腔充气后３０分钟ＰＩＰ上升１７％（Ｐ＜０．０５），ＬＣ与麻醉后和充气前相比分别下降２５．８％和２０．８％（Ｐ＜０．０１），ＰＥＣＯ２增加１９．１％（Ｐ＜０．０１）；腹腔充气后６０分钟，ＰＩＰ和ＰＥＣＯ２未继续增加，但ＬＣ继续下降，比麻醉后和充气前下降３４．２％和２７．１％（Ｐ＜０．０１）。本文显示腹腔镜胆囊切除术中肺顺应性显著下降，气道压明显升高，ＰＥＣＯ２明显增加。
he measurement of pulmonary function in the operating
room has recently becomeavaillable using corresponding equipment. The effects of abdomina
insuffiation with CO2 andTredlenburg’s position on pulmonary function were sludied by using
Datex Ultima to mea-sure pulmonary function alterations in patients undergoing laparoscopic
cholecystectomy.12 ASA Ⅰ patients undergoing laparoscopic cholecystectomy were studied.
After pre-medication with luminal and atropine, anesthesia was given with
Madazolam-Fentanyl-lsoflurane-Tracurium. We used the Ultima side stream spirometer to
measure peak inspira-tory pressure (PIP), Lung compliance (LC) and P(ET) CO2. We monitored
EKG, NIBP andSpO2 with a device of Spacelabs. IPPV was initiated at a rate of respipatory
12/MIN andminute volume was adjusted to maintain a P(ET)CO2 of 35±2 mmHg. Values were
recorded af-ter induction for 15 minutes, receiving Trendelenburg’s position for 10 minutes ,
before ab-dominal insuffiation with CO2 andafter insuffiation with CO2 for 30 and 60 minutes.
Datawere analyzed with paired student’s t test with P<0. 05 consided significant.PIP and
P(ET)CO2 has no changes and LC decreased (9. 7%, P < 0. 05) afterTrendelenburg’s position.
Insuffiation of CO2 into the abdomen for 30 minutes causedmarked decrease in LC (25. 8, P<0.
01)and increase in PIP (17%,P<0. 05)and P(ET)CO2were not further increased , but LC further
decreased (34. 2 %,P<0. 01).
出处
《中国普通外科杂志》
CAS
CSCD
1995年第5期280-281,共2页
China Journal of General Surgery
关键词
胆囊切除
肺功能
腹腔镜
Lung compliance, Pulmonary function, Laparoscopy
