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目的:观察后腹腔镜手术中CO2气腹对处于中度高原地区的泌尿外科患者血气的影响。方法:2012年1月~2014年10月对云南省玉溪地区35例泌尿外科患者行后腹腔镜手术。其中男22例,女18例,年龄23~62岁,平均48岁。术中CO2气腹压力维持在1.596~1.862kPa(12~14mm Hg)。设立3个监测时间点,分别于气腹建立0、30和60min检测动脉血酸碱度(pH)、二氧化碳分压(PaCO2)和血氧分压(PaO2)。结果:气腹建立后,患者于30min和60min时间点的动脉血pH较0min时间点显著降低(P<0.01);PaCO2显著上升(P<0.01)。30 min时间点pH、PaCO2与60min时间点pH、PaCO2相比则差异无统计学意义(P>0.05)。PaO2维持在较高水平,各时间点之间比较差异无统计学意义(P>0.05)。结论:中度高原地区患者行后腹腔镜手术有高碳酸血症的潜在风险,术中应予密切观察。
Objective: To observe the effect of CO2 pneumoperitoneum on the blood gas of urologic patients in moderate highland area after laparoscopic surgery. Methods: From January 2012 to October 2014, 35 cases of urologic patients underwent retroperitoneal laparoscopic surgery in Yuxi, Yunnan Province. Including 22 males and 18 females, aged 23 to 62 years, mean 48 years. Intraoperative CO2 pneumoperitoneum pressure was maintained at 1.596 ~ 1.862kPa (12 ~ 14mm Hg). Three monitoring time points were established. Arterial pH, PaCO2 and PaO2 were measured at 0, 30 and 60 min after pneumoperitoneum. Results: After pneumoperitoneum was established, the arterial blood pH of patients at 30min and 60min was significantly lower than that at 0min (P <0.01), PaCO2 was significantly increased (P <0.01). There was no significant difference between pH and PaCO2 at 30 min and PaCO2 at 60 min (P> 0.05). PaO2 maintained at a high level, with no significant difference between time points (P> 0.05). Conclusion: Patients with moderate altitude disease have the potential risk of hypercapnia after laparoscopic surgery, which should be closely monitored during operation.