【摘要】 目的观察在腹腔镜下胆囊切除术二氧化碳(CO2)气腹过程中丙泊酚对胃黏膜pH值的影响。方法腹腔镜下胆囊切除术患者42例,随机分为两组:异氟醚组(A组)和异氟醚、丙泊酚静脉-吸入复合组(B组),每组21例。于气腹前(T1)、气腹开始后40 min(T2)、气腹结束后40 min(T3)分别测定并记录胃黏膜与动脉血CO2分压差[P(i-a)CO2]、胃黏膜pH(pHi)值。结果A、B两组T2时P(i-a)CO2均明显高于T1时,T3时P(i-a)CO2均显著降低(P<0.05)。与A组相比,B组于T2时P(i-a)CO2显著降低,pHi显著升高(P<0.05);与T1比较,两组T3时P(i-a)CO2和pHi基本恢复至T1水平。结论丙泊酚与异氟醚静吸复合麻醉有利于稳定CO2气腹过程中胃黏膜pH,可能对维持CO2气腹过程中胃黏膜的血流灌注起到一定的积极作用,从而有利于患者术后的恢复和减少术后并发症的发生。更多还原

【Abstract】 Objective To study the influence of propoful under the two different general anesthetics(isoflurane inhalation and isoflurane-propofol intravenous-inhalation combined anesthesia) on the gastric mucosa pH in laparoscopic cholecystectomy(LC) during CO2 aeroperitoneum. Methods Forty-two patients with LC surgery were randomly divided into two groups.The patients were anesthetized with isoflurane inhalation(A group) or isoflurane-propofol intravenous-inhalation(B group). There were 21 patients in each group.The values of CO2 partial pressure difference between gastric mucosa and arterial blood,P(i-a)CO2,and pH of gastric mucosa,pHi,were recorded at T1(before aeroperitoneum),T2(40 minutes after the beginning of aeroperitoneum) and T3(40 minutes after the end of aeroperitoneum). Results P(i-a) CO2 at T2 was significantly higher than that at T1 and P(i-a)CO2 at T3 dropped significantly in both A group and B group(P<0.05).P(i-a)CO2 at T2 in group B was significantly lower than that in group A.Phi at T2 was significantly higher,and P(i-a)CO2 significantly lower in group B than those in group A(P<0.05).The values of P(i-a)CO2 and pH at T3 almost returned to the level at T1. Conclusion Isoflurane-propofol intravenous-inhalation combined anesthesia is in favor of stabling the PH value of gastric mucosa during CO2 aeroperitoneum.It improves the blood perfusion of gastric mucosa and reduces the complications after the operations.更多还原