Arterial to End-tidal Carbon Dioxide Pressure Difference during Laparoscopic Surgery in Pregnancy
Arterial to End-tidal Carbon Dioxide Pressure Difference during Laparoscopic Surgery in Pregnancy
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妊娠期腹腔镜手术期间动脉与潮气末二氧化碳压差
DOI：
10.1097/00000542-200008000-00014
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发表时间：
2000
期刊：
影响因子：
8.8
通讯作者：
S. Datta
中科院分区：
文献类型：
--
作者：
K. Bhavani;R. A. Steinbrook;David C. Brooks;S. Datta
背景：在腹腔镜手术的孕妇中，超声检查是否足以监测肺通气以降低发生严重呼吸性酸中毒的风险，目前还存在争议。在这项前瞻性研究中，测定了在行腹腔镜胆囊切除术的孕妇中，二氧化碳气腹引起的动脉至潮末二氧化碳压差（PaCO2—PetCO2）的变化。方法对8例妊娠17 ~ 30周的孕妇进行全身麻醉。取动脉血进行气体分析后，开始二氧化碳气腹。在手术过程中调整肺通气使PetCO2维持在32 mmHg左右。分别在插管时、插管终止后、拔管后和术后进行动脉血气分析。结果co2气腹前PaCO2—PetCO2平均±SD为2.4±1.5 mmHg，气腹终止时为2.6±1.2 mmHg，气腹终止后为1.9±1.4 mmHg。气腹期PaCO2和p H分别为35±1.7 mmHg和7.41±0.02 mmHg。在腹腔镜检查的各个阶段，PaCO2 -PetCO2平均值、PaCO2和p H均无显著差异。结论妊娠患者腹腔镜手术时，超声心动图可指导通气。当二氧化碳气腹期间PetCO2维持在32 mmHg时，没有发生呼吸性酸中毒。
Background There is controversy about whether capnography is adequate to monitor pulmonary ventilation to reduce the risk of significant respiratory acidosis in pregnant patients undergoing laparoscopic surgery. In this prospective study, changes in arterial to end-tidal carbon dioxide pressure difference (PaCO2–-PetCO2), induced by carbon dioxide pneumoperitoneum, were determined in pregnant patients undergoing laparoscopic cholecystectomy. Methods Eight pregnant women underwent general anesthesia at 17–30 weeks of gestation. Carbon dioxide pnueumoperitoneum was initiated after obtaining arterial blood for gas analysis. Pulmonary ventilation was adjusted to maintain PetCO2 around 32 mmHg during the procedure. Arterial blood gas analysis was performed during insufflation, after the termination of insufflation, after extubation, and in the postoperative period. Results The mean ± SD for PaCO2–-PetCO2 was 2.4 ± 1.5 before carbon dioxide pneumoperitoneum, 2.6 ± 1.2 during, and 1.9 ± 1.4 mmHg after termination of pneumoperitoneum. PaCO2 and p H during pneumoperitoneum were 35 ± 1.7 mmHg and 7.41 ± 0.02, respectively. There were no significant differences in either mean PaCO2–-PetCO2 or PaCO2 and p H during various phases of laparoscopy. Conclusions Capnography is adequate to guide ventilation during laparoscopic surgery in pregnant patients. Respiratory acidosis did not occur when PetCO2 was maintained at 32 mmHg during carbon dioxide pneumoperitoneum.