呼吸频率及潮气量对老年CO2气腹患者呼吸功能及胃黏膜pH值变化的预测价值

目的研究呼吸频率及潮气量在腹腔镜胆囊切除中CO₂气腹对老年患者呼吸功能及胃黏膜pH值(pHi)的影响。 方法42例腹腔镜胆囊切除CO₂气腹的老年患者(≥65岁)，在全麻CO₂气腹压力为13mmHg(1mmHg＝0.133kPa)，依术中呼吸频率、潮气量分为A、B组。A组22例(呼吸频率12次/min，潮气量9ml/kg)，B组20例(呼吸频率14次/min，潮气量7ml/kg)，分别于气腹前(T1)、气腹后20min (T2)、气腹结束后20min(T3)监测气道压力峰值(PPEAK)、呼气末CO₂分压(P_ETCO₂)及pHi值。 结果A、B两组在PPEAK、P_ETCO₂及pHi参数方面各组组间T2同节点比较，差异有统计学意义(分别为(25.68±2.61)mmHg，(22.03±4.12)mmHg；t＝3.46 ，P<0.05；(35.68±1.61)mmHg，(33.09±1.12)mmHg；t＝5.99 ，P<0.05；(7.08±0.08)mmHg，(7.26±0.05)mmHg；t＝8.64，P<0.05]。 结论使用适当的高通气频率、低潮气量通气方法，对CO₂气腹腹腔镜胆囊切除老年患者的呼吸功能及胃黏膜pH值具有正向作用。

Forecast value of repiratory frequency and tidal volume for changes of CO2 pneumoperitoneum on respiratory system and gastric intramucosal pH of aged patients during laparoscopic cholecystectomy

ObjectiveTo study the effects of repiratory frequency and tidal volume for CO₂ pneumoperitoneum on respiratory system and gastric intramucosal pH of aged patients during laparoscopic cholecystectomy. MethodsForty-two patients were divided into group A(f=12, Vt=9ml/kg, n=22) and group B(f=14, Vt=7ml/kg, n=20). PPEAK, P_ETCO₂ and pHi were monitored before pneumoperitoneum (T1) 20min after pneumoperitoneum (T2) and relieving pneumoperitoneum (T3) respectively. ResultsPPEAK, P_ETCO₂ at T2 were significantly higher than that at T1 in the same groups (P<0.05). pHi of B group at T2 was significantly lower than that at T1(P<0.05). There were significant difference of T2 indexes in group A compared with group B(P<0.05). ConclusionThe method of proper frequency rate and tidal volume in CO₂ pneumoperitoneum may act positively for respiratory system and pHi of aged patients during laparoscopic cholecystectomy .