腹腔镜手术中突然无CO_2的应急处理

目的:探讨腹腔镜术中突然无CO2时使用自行设计的应急腹腔充气装置向腹腔充气继续施行手术的可行性。方法:使用本装置建立空气气腹与常规CO2气腹行腹腔镜动物实验,观察建立的手术空间及使用钩状电极时的火花情况,监测动物在麻醉、充气、手术过程中脉搏(pulse,P)、动脉血氧饱和度(SpO2)的变化及术后生存情况,取得一定经验后应用于临床。结果:动物在麻醉、术中、术后半小时P、SpO2的变化曲线一致,能建立足够的手术空间,使用钩状电极切割时无爆炸,火花不明显,术后动物生存良好。使用本装置完成1例腹腔镜异位妊娠取胚术,手术顺利,术中血压(blood pressure,BP)、P、SpO2平稳,术后6h患者BP、P、SpO2正常。结论:腹腔镜术中突然无CO2时用自行设计的应急腹腔充气装置是安全的,具有一定的实用性与可操作性。

Emergency handling with unexpected non CO2 in laparoscopic surgery

Objective:To investigate the feasibility of self-designed emergency abdominal cavity inflatable devices to insufflate pneumoperitoneum when carbon dioxide suddenly runs out in laparoscopic surgery.Methods:Animal experiments were performed to establish air pneumoperitoneum and conventional CO2 pneumoperitoneum by this device in laparoscopic surgery.We observed the established surgical space and spark when hook electrode was used,and monitored the changes of pulse and SpO2 of pigs during anesthesia,insufflation and surgery.Survival situation after surgery was also observed.When sufficient experience had been obtained,this surgery was applied in clinic.Results:The change curves of the pulse and SpO2 of the two pigs were consistent when anesthesia was performed,during and after half an hour of surgery,and adequate surgical space could be established.When hook electrodes were used,no explosions or obvious sparks were observed.The two pigs survived well after operations.The device was used to complete one case of laparoscopic removal of ectopic pregnancy embryo,and the operation was completed successfully.The blood pressure,pulse and SpO2 were stable during operation,and these parameters were normal six hours after surgery.Conclusions:Self-designed emergency abdominal cavity inflatable device is safe and feasible in laparoscopic surgery when carbon dioxide runs out suddenly.