Abu-Rafea Basim, Vilos George A, Vilos Angelos G, Hollett-Caines Jackie, Al-Omran Mohammad
St. Joseph's Health Care, Department of Obstetrics and Gynecology, The University of Western Ontario, London, Ontario, Canada.
J Minim Invasive Gynecol. 2006 May-Jun;13(3):205-10. doi: 10.1016/j.jmig.2006.02.004.
To determine height, weight, body mass index (BMI), parity, and age effect on the volume of CO2 pneumoperitoneum during laparoscopic access in women.
Prospective observational cohort study (Canadian Task Force classification II-1).
University-affiliated teaching hospital.
From January through June 2004, 100 healthy women underwent operative laparoscopic surgery consecutively by the senior author (GAV). Indications were: chronic pelvic pain (CPP, n = 66), pelvic mass (n = 7), CPP and pelvic mass (n = 4), infertility (n = 23). Median (range) height, weight, BMI, parity and age were 1.65 m (1.45-1.85 m), 70 kg (43-118 kg), 25.5 kg/m2 (17-39 kg/m2), 1.1 (0-5), and 34 years (19-58 years), respectively.
While in supine position, patients received general endotracheal anesthesia and muscle relaxants. Pneumoperitoneum was established by reusable Veres needle. The insufflated CO2 volume was serially recorded at intraperitoneal insufflation pressures (IPIPs) of 10, 15, 20, 25, and 30 mm Hg. The primary 10-mm trocar was introduced at IPIP of 30 mm Hg. Upon entering the peritoneal cavity, the abdominal contents were visualized with the laparoscope to ensure there was no injury, and the IPIP was immediately reduced back to the operating pressure of 15 mm Hg before switching the patient to the Trendelenburg position.
The mean (SD) insufflated CO2 volumes at 10, 15, 20, 25, and 30 mm Hg were 1.7 (0.74) L, 3.1 (0.9) L, 3.96 (1.05) L, 4.42 (1.1) L and 4.72 (1.14) L, respectively. Using multivariate analysis, we demonstrated that at 20 to 30 mm Hg the insufflated CO2 volume correlated positively with the height, weight and BMI of women. Parity correlated positively at all pressures. There was no correlation with age at any pressure.
Higher CO2 volume is required to establish appropriate pneumoperitoneum in tall, overweight, and parous women at 20 to 30 mm Hg. Setting the IPIP at 20 to 30 mm Hg before primary trocar insertion eliminates the need to monitor CO2 insufflated volume regardless of women's age, parity, and body habitus.
确定身高、体重、体重指数（BMI）、产次及年龄对女性腹腔镜手术时二氧化碳气腹量的影响。
前瞻性观察性队列研究（加拿大工作组分类II-1）。
大学附属医院。
2004年1月至6月，100名健康女性由资深作者（GAV）连续进行腹腔镜手术。手术指征为：慢性盆腔疼痛（CPP，n = 66）、盆腔肿物（n = 7）、CPP合并盆腔肿物（n = 4）、不孕症（n = 23）。身高、体重、BMI、产次及年龄的中位数（范围）分别为1.65米（1.45 - 1.85米）、70千克（43 - 118千克）、25.5千克/平方米（17 - 39千克/平方米）、1.1（0 - 5）及34岁（19 - 58岁）。
患者仰卧位时接受全身气管内麻醉及肌肉松弛剂。使用可重复使用的Veres针建立气腹。在腹腔内充气压力（IPIP）为10、15、20、25及30毫米汞柱时连续记录充入的二氧化碳量。在IPIP为30毫米汞柱时插入10毫米的主套管针。进入腹腔后，用腹腔镜观察腹腔内容物以确保无损伤，在将患者转为头低脚高位前，立即将IPIP降至15毫米汞柱的手术压力。
在10、15、20、25及30毫米汞柱时，平均（标准差）充入的二氧化碳量分别为1.7（0.74）升、3.1（0.9）升、3.96（1.05）升、4.42（1.1）升及4.72（1.14）升。多因素分析显示，在20至30毫米汞柱时，充入的二氧化碳量与女性的身高、体重及BMI呈正相关。在所有压力下，产次均呈正相关。在任何压力下与年龄均无相关性。
在20至30毫米汞柱时，身材高大、超重及经产女性建立合适气腹需要更高的二氧化碳量。在插入主套管针前将IPIP设置为20至30毫米汞柱，无论女性年龄、产次及身体状况如何，均无需监测二氧化碳充入量。
