Hong J Y, Chung K H, Lee Y J
Department of Anesthesiology, Sungkyunkwan University School of Medicine, Suwon, Korea.
Yonsei Med J. 1999 Aug;40(4):307-12. doi: 10.3349/ymj.1999.40.4.307.
We investigated the ventilatory changes in healthy patients without cardiopulmonary pathology during elective laparoscopic cholecystectomy in the head-up position. During surgery, intraabdominal pressure was maintained at 15 mmHg by a CO2 insufflator, and minute ventilation was controlled with a constant tidal volume and fixed respiratory rate. PETCO2 was monitored continuously and recorded every minute. Basic hemodynamic and ventilatory parameters were measured before anesthesia; after induction of anesthesia; at 5 min, 10 min and 30 min after peritoneal insufflation; and 5 min and 10 min after exsufflation. Arterial blood samples were obtained 3 times to calculate D(a-A)CO2, VD/VT, and Vco2. The latent period of PETCO2 change was 2.9 min, the ascending period was 12.6 min, and the descending period was 12.2 min. During the 71.5 min of pneumoperitoneum, V(I), VE, peak and plateau Paw increased, while Cdyn decreased significantly. Peritoneal insufflation or exsufflation also resulted in a significant change of D(a-A)CO2, D(a-A)O2, and Vco2. The anesthesiologist must be aware of both hemodynamic and ventilatory changes and must be ready to respond promptly and adequately.
我们研究了在择期腹腔镜胆囊切除术头高位时，无心肺疾病的健康患者的通气变化。手术过程中，通过二氧化碳气腹机将腹内压维持在15 mmHg，分钟通气量通过恒定潮气量和固定呼吸频率进行控制。持续监测呼气末二氧化碳分压（PETCO2）并每分钟记录一次。在麻醉前、麻醉诱导后、气腹后5分钟、10分钟和30分钟以及放气后5分钟和10分钟测量基本血流动力学和通气参数。采集3次动脉血样本以计算肺泡-动脉血氧分压差（D(a-A)CO2）、生理死腔量/潮气量（VD/VT）和二氧化碳排出量（Vco2）。PETCO2变化的潜伏期为2.9分钟，上升期为12.6分钟，下降期为12.2分钟。在气腹的71.5分钟内，吸气峰流速（V(I)）、分钟通气量（VE）、气道峰压和平台压升高，而动态顺应性（Cdyn）显著降低。气腹或放气也导致D(a-A)CO2、肺泡-动脉血氧分压差（D(a-A)O2）和Vco2发生显著变化。麻醉医生必须意识到血流动力学和通气的变化，并必须准备好迅速做出充分反应。
