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目的 探讨不同麻醉下妇科腹腔镜手术气腹和体位 (T位 )对呼吸功能的影响程度 .方法 妇科腹腔镜手术 40例 ,随机分成硬膜外麻醉 (EA)组和全麻 (GA)组各 2 0例 .ASAⅠ级 .术中维持气腹压 1.6kPa、2 0°T位 .监测呼吸、血气指标 .结果 (1)两组气腹及T位后VT(潮气量 )、MV(分钟通气量 )增加 ,EA组PETCO2 (呼气末二氧化碳分压 )高于GA组 ,SpO2 (脉搏氧饱和度 )低于GA组 .GA组气腹及T位后RR和VT 都保持稳定 ,气腹后PPEAK(气道峰压 )增加 ;C(肺顺应性 )下降 ;T位后PPEAK进一步增加 . (2 )EA组T位后各时点的动脉血pH值 (<7.35 0 )均比GA组低 ,气腹及T位后PaCO2 (动脉血二氧化碳分压 )保持在 5 .9～ 6 .0kPa,明显高于GA组 .GA组PaO2 (动脉血氧分压 )、SaO2 (动脉血氧饱和度 )水平明显高于EA组 .结论 妇科腹腔镜手术气腹 (腹内压 1.6kPa)和 2 0°T位可引起气道阻力增加 ;肺顺应性下降 ,肺有效通气量明显降低 ,EA下有发生呼吸性酸血症和低氧血症的趋势 .
Objective To investigate the effects of pneumoperitoneum and position (T-position) on respiratory function under gynecological laparoscopic gynecology under different anesthesia.Methods Forty gynecological laparoscopic operations were randomly divided into epidural anesthesia (EA) group and general anesthesia (GA) Twenty-two ASA grade Ⅰ, intraoperative pneumoperitoneum pressure 1.6kPa, 20 ° T position were monitored.Respiratory and blood gas indexes were monitored.Results (1) After the pneumoperitoneum and T position VT (tidal volume), MV Volume), PETCO2 (end-tidal carbon dioxide partial pressure) in EA group was higher than GA group, while SpO2 (pulse oxygen saturation) was lower than GA group.After pneumoperitoneum and T-position, (PPEAK) increased; C (pulmonary compliance) decreased; PPEAK increased further after T position. (2) Arterial blood pH values (<7.35 0) , PaCO2 (arterial partial pressure of carbon dioxide) after pneumoperitoneum and T position was maintained at 5.9 ~ 6.0 kPa, which was significantly higher than that in GA group. PaO2 (PaO2), SaO2 (PaO2) (P <0.05) .Conclusion Gynecological laparoscopic pneumoperitoneum (intra-abdominal pressure 1.6kPa) and 20 ° T-position can cause increased airway resistance; decreased lung compliance and effective pulmonary ventilation , There is a tendency respiratory acidosis and hypoxemia under EA.