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全麻下妇科腹腔镜手术体位的CO_2气腹对患者呼吸循环的病理生理影响

作　者: 刘玉婷
导　师: 蒋晖
学　校: 新疆医科大学
专　业: 麻醉学
关键词: 全身麻醉妇科腹腔镜头低臀高位 CO2气腹压力
分类号: R614
类　型: 硕士论文
年　份: 2009年
下　载: 35次
引　用: 0次
阅　读: 论文下载

内容摘要

目的:探讨全麻下妇科腹腔镜手术头低臀高体位(Trendelenburg位)和CO2气腹两因素在不同水平下对患者呼吸循环的病理生理影响。方法:妇科腹腔镜手术患者120例,按符合纳入标准的手术顺序随机分到四组并给予不同处理(A组为对照组:体位为0°气腹压力为0mmHg;B组为体位组:体位为20°气腹压力为0mmHg;C组为气腹组:体位为0°气腹压力为15mmHg;D组为体位×气腹组:体位为20°气腹压力为15mmHg ),统一给予全身麻醉,麻醉诱导气管插管后加入处理因素15min后,测量并记录4组患者的各实验指标值:气道压力(pressure of airway ,Paw)、吸气峰压(Peak Inspiratory Pressure ,PIP)、吸气平台压、呼气末二氧化碳张力(pressure of end-tidal carbon dioxide,PetCO2)、二氧化碳分压(partial pressure of carbon dioxide ,PaCO2)、氧分压(partial pressure of oxygen ,PaO2)、PH、平均动脉压(mean arterial pressure ,MAP)、心率(heart rate ,HR)。实验为两因素两水平的析因设计,故针对体位和气腹两因素及这两个因素的交互作用做方差分析,用SPSS17.0统计软件处理,比较两因素不同水平的平均效应和因素间的不同水平组合下的平均效应,两因素间是否存在交互作用。并对四组(即对照组、体位组、气腹组、体位×气腹组)患者测得的以上9项实验指标进行方差分析,比较各实验指标在四组之间有无统计学意义及两两比较是否有统计学意义,P<0.05为差异有显著性。结果:体位和气腹两因素除了对PaO2无统计学意义上的影响,其他各实验指标均受其影响。从交互作用表可知除PaO2外,体位和气腹因素对Paw、PIP、吸气平台压、PetCO2、PaCO2、PH、MAP、HR这八项指标来说均有交互作用,在体位20°×气腹压力15mmHg时达最大;四组比较时以上八项实验指标均差异有显著性(P<0.05)。结论:全麻下妇科腹腔镜手术对于Paw、PIP和吸气平台压、PetCO2、PaCO2、PH、MAP、HR这八项实验指标来说体位和气腹两因素的交互作用均比体位或气腹单因素的作用要明显,在体位20°×气腹压力15mmHg时达最大,即两因素有协同作用。头低脚高体位和CO2气腹对患者呼吸和循环的改变有显著性。Objective:To study the pathophysiology effects of head–low and feet -high postion(trendelenburg) and CO2 pneumoperitoneum to respiratory and circulatory under conditions of gynecologic laparoscopy operation with general anesthesia.Methods: Regarding 120 cases of gynecologic laparoscopy operations, freely divided into 4 groups which are given different methods (group A is matched group: trendelenburg is 0°, pneumoperitoneum pressure is 0mmHg,group B is trendelengurg group:trendelenburg is 20°, pneumoperitoneum pressure is 0mmHg, group C is pneumoperitoneum group: trendelenburg is 0°,pneumoperitoneum pressure is 15mmHg,group D is trendelengurg×pneumoperitoneum group: trendelenburg is 20°, pneumoperitoneum pressure is 15mmHg) , take all with general anesthesia, 15 minutes after adding disposal factors through anesthesia induction pipe, test and record the data of 4 groups: ,Paw(pressure of airway),,PIP( Peak Inspiratory Pressure), inspiratory plateau pressure, PetCO2(pressure of end-tidal carbon dioxide), PaCO2(partial pressure of carbon dioxide), PaO2 (partial pressure of oxygen), PH, MAP(mean arterial pressure)、HR(heart rate). Test is designed based on two factors and two levels. Against trendelenburg and pneumoperitoneum these two factor’s interaction, we made analysis of variance. SPSS17.0 statistical software is taken to compare the average effect of different factors and different levels, to test if the two different factors exsist interaction. Anyalysis of variance is made to the four groups (matched group, trendelengurg group, pneumoperitoneum group and trendelengurg×pneumoperitoneum group), comparing if there is any statistics significance,P<0.05 means difference has significance, Flup complicatio’s incidence rate.Results: Trendelenburg and pneumoperitoneum factors has

全文目录

摘要  7-8
ABSTRACT  8-10
前言  10-14
资料与方法  14-17
  1. 研究对象  14
  2. 仪器与试剂  14
  3. 研究内容  14-16
  4. 统计学处理  16-17
结果  17-25
讨论  25-32
小结  32-33
致谢  33-34
参考文献  34-39
综述  39-47
附录  47-48
攻读硕士学位期间发表的学术论文  48-49
导师评阅表  49

全麻下妇科腹腔镜手术体位的CO_2气腹对患者呼吸循环的病理生理影响

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