预灌洗肾上腺素盐水对后腹腔镜手术患者二氧化碳吸收的影响

发布时间：2018-03-22 02:35

本文选题：肾上腺素　切入点：血二氧化碳分压　出处：《医药论坛杂志》2015年05期 　论文类型：期刊论文

【摘要】：目的探讨后腹腔镜手术前预灌洗1∶50万肾上腺素盐水对后腹腔镜手术患者二氧化碳(CO2)吸收的影响。方法选取60例择期接受后腹腔镜泌尿外科手术的患者,采用随机数字表法,将患者分为两组(n=30):预灌洗1∶50万肾上腺素盐水组(AD组)和预灌洗0.9%氯化钠注射液组(NS组)。患者于人造气腹形成后、手术开始前,AD组患者预灌洗1∶50万肾上腺素盐水300 ml,NS组患者预灌注0.9%氯化钠注射液300 ml,3 min后腹腔镜下吸引出人工气腹内的预灌洗液。分别于灌洗前(T0)、灌洗后10 min(T1)、30 min(T2)、60 min(T3)、90 min(T4)和120 min(T5)时记录患者心率(HR)、平均动脉血压(MAP)、血氧饱和度(Sp O2),血氧分压(Pa O2)、血二氧化碳分压(Pa CO2)、呼气末二氧化碳分压(PETCO2)。根据公式计算CO2排出量(VCO2)。记录患者术中心律失常及术后头痛、心悸、烦躁等不良反应发生率。结果两组患者T0时HR、MAP、Sp O2、Pa O2、Pa CO2、PETCO2和VCO2比较差异均无统计学意义(P0.05)。两组患者各时间点Sp O2、Pa O2比较差异无统计学意义(P0.05)。与NS组比较,AD组患者T1~T5时心率降低(P0.05),两组患者各时点MAP差异无统计学意义(P0.05)。与NS组比较,AD组T1~T5时Pa CO2、PETCO2和VCO2均降低(P0.05)。与NS组比较,AD组患者术中心律失常及术后头痛、心悸、烦躁等不良反应发生率均降低(P0.05)。结论后腹腔镜手术预灌洗1∶50万肾上腺素盐水能减少术中CO2的吸收,可预防术中出现高碳酸血症并能减少患者术中及术后不良反应发生率,安全且有效。
[Abstract]:Objective to investigate the effect of prelavage of 1: 500 000 epinephrine before retroperitoneal laparoscopic surgery on CO _ 2 absorption in retroperitoneal laparoscopic surgery patients. Methods 60 patients undergoing retroperitoneal laparoscopic urological surgery were selected and randomized digital table method was used. The patients were divided into two groups: 1: 500 000 epinephrine group (AD group) and 0.9% sodium chloride injection group (NS group). Before operation, AD patients were preperfused with 1: 500 000 epinephrine (300ml) and NS group (0.9% sodium chloride injection 300ml / 3 min). The prelavage fluid in artificial pneumoperitoneum was drawn out by laparoscope after 3 min. Heart rate, mean arterial blood pressure (MAPP), blood oxygen saturation (SPO _ 2), partial pressure of oxygen (Pao _ 2), partial pressure of blood carbon dioxide (Paco _ 2), end-expiratory carbon dioxide pressure (PETCO _ 2) were recorded at 90 min T _ 4 and 120 min T _ 5). The CO2 excretion was calculated according to the formula. The operation center of the patient was recorded. Arrhythmia and postoperative headache, Palpitations, Results there was no significant difference in VCO2 and CO _ 2 and VCO2 between the two groups at T _ 0. There was no significant difference in T1~T5 between the two groups at different time points (P _ (0.05) O _ (2) O _ (2) O _ (2) O _ (2) O _ (2) O _ (2) O _ (2) O _ (2) O _ (2)) compared with that in the NS group (P < 0.05). There was no significant difference in MAP between the two groups at different time points (P 0.05). Compared with NS group, Pa CO 2 PET CO 2 and VCO2 decreased in AD group, and the arrhythmia during operation and headache after operation in AD group were compared with those in NS group. The incidence of adverse reactions such as palpitation and irritability decreased P0.050.Conclusion Prelavage of 1: 500,000 epinephrine in retroperitoneal laparoscopic surgery can reduce the absorption of intraoperative CO2, prevent hypercapnia and decrease the incidence of adverse reactions during and after operation. Safe and effective.
【作者单位】：中牟县人民医院麻醉科;
【分类号】：R614

【参考文献】