摘要
目的探讨压力梯度控制方案对妇科腹腔镜手术患者二氧化碳(CO_(2))气腹早期阶段循环呼吸功能的影响。方法选取江苏省中医院2018年11月1日至2019年3月31日择期手术的妇科腹腔镜手术患者100例作为研究对象,采用随机数字表法分为试验组和对照组,每组50例,试验组采用压力梯度控制的方法建立CO_(2)气腹,即将气腹压力设为5、9、12 mmHg(1 mmHg=0.133 kPa)逐渐上升3个梯度,并在到达相应的梯度后分别维持1 min直至12 mmHg;对照组采用常规方法,即将气腹压力直接设置为12 mmHg,开始充气直至到达预设压力。观察2组气腹前与气腹后15 min内的循环呼吸指标收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、呼吸末CO_(2)分压(P_(ET)CO_(2))、气道峰压(P_(peak))、动脉血CO_(2)分压(PaCO_(2))的改变情况以及循环呼吸干预的情况。结果试验组气腹后15 min内SBP、DBP、MAP、HR、P_(ET)CO_(2)、P_(peak)、PaCO_(2)最大值分别为(117.08±13.07)mmHg、(77.08±9.43)mmHg、(90.06±10.33)mmHg、(69.04±9.10)次/min、(36.00±3.37)mmHg、(20.18±2.74)cmH_(2)O(1 cmH_(2)O=0.098 kPa)、(40.65±3.31)mmHg,对照组分别为(140.63±18.34)mmHg、(91.90±11.79)mmHg、(107.25±12.85)mmHg、(77.67±13.57)次/min、(38.31±4.31)mmHg、(24.81±4.26)cmH_(2)O、(45.19±4.49)mmHg,2组比较差异有统计学意义(t值为-7.269~-2.945,均P<0.01)。试验组气腹前后SBP、DBP、MAP、HR、P_(ET)CO_(2)、P_(peak)、PaCO_(2)波动幅度分别为(10.14±6.34)mmHg、(8.98±5.88)mmHg、(9.14±5.44)mmHg、(5.80±2.48)次/min、(3.27±1.43)mmHg、(2.65±1.54)cmH_(2)O、(4.08±1.74)mmHg,对照组分别为(33.65±14.87)mmHg、(26.17±9.73)mmHg、(28.04±9.97)mmHg、(17.63±9.77)次/min、(6.98±2.89)mmHg、(7.44±2.35)cmH_(2)O、(9.52±3.92)mmHg,2组比较差异有统计学意义(t值为-11.841~-8.048,均P<0.01)。气腹后15 min内,试验组循环干预情况4.08%(2/49),低于对照组的22.92%(11/48),差异有统计学意义(χ^(2)值为7.412,P<0.01),试验组呼吸干预情况0(0/49),低于对照组的10.42%(5/48),差异有统计学意义(Fisher确切概率法,P<0.05)。结论在妇科腹腔镜手术中,采用压力梯度控制方案建立CO_(2)气腹,有利于减少早期气腹对循环呼吸功能的影响,更好地维持循环呼吸功能的相对稳定,有效降低循环呼吸波动后的麻醉相关干预,有利于患者的手术安全。
Objective To investigate the effects of pressure gradient controlled carbon dioxide(CO_(2))pneumoperitoneum establishment in patients with gynecological laparoscopic surgery on early circulatory and respiratory function.Methods From November 1,2018 to March 31,2019,100 case of gynecological laparoscopic surgery who were scheduled to undergo elective surgery in Jiangsu Hospital of Traditional Chinese Medicine were enrolled and divided into experimental group(50 cases)and control group(50 cases)by random number table method.The experimental group used pressure gradient control method to establish CO_(2) pneumoperitoneum,that is,the pneumoperitoneum pressure was set to 5,9,12 mmHg(1 mmHg=0.133 kPa)gradually rising three gradients,and after reaching the corresponding gradient,they were maintained for 1 minute to 12 mmHg;the control group used conventional method,that was,the pneumoperitoneum pressure was set directly to 12 mmHg,and began to inflate until reaching the preset pressure.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR),end-of-breath partial pressure of CO_(2)(P_(ET)CO_(2)),peak airway pressure(P_(peak)),arterial blood partial pressure of CO_(2)(PaCO_(2))and the intervention of cirulation and respiration were compared between the two groups before and within 15 minutes after pneumoperitoneum.Results The max values of SBP,DBP,MAP,HR,P_(ET)CO_(2),P_(peak) and PaCO_(2) within 15 minutes after pneumoperitoneum in the experimental group were(117.08±13.07)mmHg,(77.08±9.43)mmHg,(90.06±10.33)mmHg,(69.04±9.10)times/min,(36.00±3.37)mmHg,(20.18±2.74)cmH_(2)O(1 cmH_(2)O=0.098 kPa),(40.65±3.31)mmHg,higher than that of the control group(140.63±18.34)mmHg,(91.90±11.79)mmHg,(107.25±12.85)mmHg,(77.67±13.57)times/min,(38.31±4.31)mmHg,(24.81±4.26)cmH_(2)O,(45.19±4.49)mmHg,the differences were statistically significant(t values were-7.269--2.945,all P<0.01).The amplitudes of SBP,DBP,MAP,HR,P_(ET)CO_(2),P_(peak) and PaCO_(2) fluctuations before and after pneumoperitoneum in the experimental group were(10.14±6.34)mmHg,(8.98±5.88)mmHg,(9.14±5.44)mmHg,(5.80±2.48)times/min,(3.27±1.43)mmHg,(2.65±1.54)cmH_(2)O,(4.08±1.74)mmHg,while the control group were(33.65±14.87)mmHg,(26.17±9.73)mmHg,(28.04±9.97)mmHg,(17.63±9.77)times/min,(6.98±2.89)mmHg,(7.44±2.35)cmH_(2)O,(9.52±3.92)mmHg,the differences were statistically significant(t values were-11.841--8.048,all P<0.01).Within 15 minutes after pneumoperitoneum,circulatory intervention was 4.08%(2/49)in the experimental group,lower than that in the control group 22.92%(11/48),the difference was statistically significant(χ^(2)=7.412,P<0.01).Respiratory intervention in the experimental group was 0(0/49),lower than that in the control group 10.42%(5/48),the difference was statistically significant(Fisher test,P<0.05).Conclusions In gynecological laparoscopic surgery,using pressure gradient control method to establish CO_(2) pneumoperitoneum is conducive to reducing the effect of early pneumoperitoneum on circulatory and respiratory function,maintaining the relative stability of circulatory and respiratory function,effectively reducing anesthesia-related interventions after circulatory and respiratory fluctuations,and is conducive to the safety of patients.
作者
吴延华
王琰
徐昌霞
肖蕾
吴炜
於春燕
张小敏
陈欢欢
Wu Yanhua;Wang Yan;Xu Changxia;Xiao Lei;Wu Wei;Yu Chunyan;Zhang Xiaomin;Chen Huanhuan(Department of Operating Room,Jiangsu Traditional Chinese Medicine Hospital,Nanjing 210029,China)
出处
《中国实用护理杂志》
2020年第25期1921-1926,共6页
Chinese Journal of Practical Nursing
基金
江苏省中医院2018年医院创新发展基金专项课题(Y2018CX42)。
关键词
腹腔镜
气腹
妇科腹腔镜手术
呼吸循环功能
Laparoscopy
Pneumoperitoneum
Laparoscopic gynecological surgery
Respiratory and circulatory function
