Wakizaka Y, Sano S, Koike Y, Nakanishi Y, Uchino J
Department of Surgery, Sapporo City Hospital, Japan.
Nihon Geka Gakkai Zasshi. 1994 May;95(5):336-42.
We studied on the effects of carbon dioxide insufflation during laparoscopic cholecystectomy on the arterial blood gas analysis and urine output. Intra-abdominal pressure was increased up to either 10cmH2O or 15cmH2O, and we compared the PaCO2 values before and during insufflation. Both increase of PaCO2 and decrease in pH were larger in intra-abdominal pressure of 15cmH2O than 10cmH2O. In the intra-abdominal pressure 15cmH2O group, the increase of PaCO2 by CO2 peritoneal insufflation was significantly larger in operative time of more than 60 minutes group than in less than 60 minutes group, but no significant changes were observed in 10cmH2O group. In the group of obesity index of more than 120, elevation levels of PaCO2 by CO2 insufflation were significant, but in the group of less than 120 no significant elevation were observed. The tendency that the urine output during operation was decreased as increase of intra-abdominal pressure or operative time, but the obesity had no definite effects on urine output. Insufflation of the abdomen with CO2 caused large changes in PaCO2 or pH in the patients with a previous history of major cardiopulmonary disorder. It was shown that the low insufflation pressure and short operative time is good for the maintenance of normal physiological state.
我们研究了腹腔镜胆囊切除术期间二氧化碳气腹对动脉血气分析和尿量的影响。将腹腔内压力升高至10cmH₂O或15cmH₂O，比较气腹前后的PaCO₂值。腹腔内压力为15cmH₂O时PaCO₂的升高和pH值的降低均大于10cmH₂O时。在腹腔内压力为15cmH₂O组中，手术时间超过60分钟组因CO₂腹腔充气导致的PaCO₂升高明显大于手术时间少于60分钟组，但10cmH₂O组未观察到明显变化。在肥胖指数超过120的组中，CO₂充气导致的PaCO₂升高显著，但在肥胖指数低于120的组中未观察到显著升高。术中尿量随腹腔内压力或手术时间增加而减少的趋势明显，但肥胖对尿量无确切影响。对于有严重心肺疾病史的患者，CO₂气腹会导致PaCO₂或pH值发生较大变化。结果表明，低充气压力和短手术时间有利于维持正常生理状态。
