【摘要】 目的探讨呼气末二氧化碳分压(PETCO2)监测在腹腔镜手术中的作用。方法监测68例患者全麻腹腔镜手术中潮气量(VT)和PETCO2,观察腹腔充气前、后VT及PETCO2的变化,同时比较静脉复合全麻(静脉组)、静吸(异氟醚)复合全麻(静吸组)及加吸氧化亚氮(N2O)静吸复合全麻(加吸N2O静吸组)对VT和PETCO2的影响。结果充气后各组VT均显著降低,PETCO2均显著升高(P值均<0．001)。充气前,静脉组与静吸组PETCO2的差异无显著性(P>0．05),但两组均高于加吸N2O静吸组(P值均<0．05);充气后,静吸组的PETCO2较静脉组增高(P<0．05),但两组与加吸N2O静吸组的差异无显著性(P值均>0．05)。结论腹腔镜手术中VT随着气腹的增加明显下降,调整VT有助于提高手术安全性。此外,全麻方式的选择也可显著影响腹腔镜手术中VT及PETCO2的改变,加吸异氟醚或N2O复合静脉全麻会使PETCO2进一步升高。因此,PETCO2监测是腹腔镜手术中不可缺少的监测指标之一。更多还原

【Abstract】 Objective To appraise the monitoring effect of end-tidal carbon dioxide pressure (PET CO2) during laparoscopic surgery. Method PETCO2 and tidal volume(VT) were monitored before and 3 min after carbon di-oxide(CO2) pneumoperitoneum in 68 patients undergoing laparoscopic surgery under general anesthesia. Simultaneously, we compared the effects of three types of anesthesia i. e. total intravenous anesthesia (groupⅠ), combined intravenous and inhalation anesthesia(groupⅡ), and Nitrous oxide(N2O) analgesia in addition to inhalation and intravenous anesthesia (groupⅢ). Results After pneumoperitoneum, VT decreased and PETCO2 increased in all groups comparing with those before initiating the insufflation(P < 0. 001). Before pneumoperitoneum, PETCO2 of groupⅠhad no significant difference with that of groupⅡ(P > 0. 05) , but both of them were higher than that of groupⅢ(P < 0. 05). However, after the pneumoperitoneum, PETCO2 of groupⅡwas higher than that of groupⅠ(P > 0. 05), but not significantly different with that of groupⅢ(P < 0. 05). Conclusion VT decreases during CO2 pneumoperitoneum, and needs to be adjusted basing on PETCO2. The changes of VT and PETCO2 are also affected by general anesthesia. PETCO2 would increase further when using isoflurance or N2O in intravenous anesthesia. Therefore, PETCO2 monitoring is essential for iaparoscopic surgery. (Shanghai Med J, 2006, 29:725-727)更多还原