| 摘要: |
| 目的观察不同体位腹腔镜手术中食管下段p H值的变化,探讨气腹与体位对胃内容物反流的影响。方法腹腔镜妇科手术患者30例分为A组,腹腔镜胆囊切除术的女性患者30例分为B组。两组均行气管插管全身麻醉,气腹压力13 mm Hg,监测并记录气腹前（T1）、气腹平卧位（T2）、气腹调节体位（A组为头低足高30°,B组为头高足低30°）后10 min（T3）的食管下段p H值（p Hi）,术后分析p Hi监测结果。结果 A组患者p HiT2时较T1时小（P〈0.05）,T3时较T2时小（P〈0.05）;B组患者p HiT2时较T1时小（P〈0.05）,T3时较T2时大（P〈0.05）;两组间T1和T2时p Hi无显著差异,A组T3时p Hi小于B组（P〈0.05）。A组有1例＂p H〈4反流事件＂即酸反流,发生于气腹平卧位至手术结束之间,共4次,最长持续时间45 min,最低p H值0.9;B组未发生酸反流。结论腹腔镜手术增加了胃内容物反流的风险,尤其是采取头低足高位时。 |
| 关键词: 气腹 体位 食道下段p H值 胃内容物反流误吸 |
| DOI：10.3969/j. issnl008 - 0392.2014.05.014 |
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| 基金项目: |
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| Effects of pneumoperitoneum and different positions on gastric regurgitation in laparoscopic operations |
| TANG Chen-cheng,ZHANG Xiao-qing |
| (Dept. of Anesthesiology, Tongji Hospital, Tongji University, Shanghai 200065, China) |
| Abstract: |
| Objective To investigate the effect of pneumo peritoneum and different positions on gastric regurgitation in laparoscopic operations. Methods Sixty female patients under going laparoscopic operation were included in the study,including30 cases with laparoscopic gynecological operation（ group A）,and 30 cases with laparoscopic cholecystectomy（ group B）. Intraabdominal pressure was maintained in 13 mm Hgduringthe operation. Lowesophageal p H（ p Hi） was continually monitored before insufflation（ T1）,at insufflation in the supine position（ T2）,10 min after insufflation in Trendelenburgor reverse Trendelenburgposition（ T3）. Results There were nosignificant differences in p Hivalue at T1 and T2between twogroups. p Hiincreased from T1 toT2（P〈0. 05） in both groups. p Hidecreased from T2 toT3in group A（ P〈0. 05）,while it increased from T2 toT3in group B（ P〈0. 05）. p Hiwas lower in group A than that in group B at T3（P〈0. 05）.Regurgitation with p Hi 4 was observed 4 times in one case of group A,the longest episode was 45 min,the lowest p Hiwas 0. 9. Noregurgitation was observed in group B. Conclusion Laparoscopic operation can increase the risk of regurgitation,especially in Trendelenburg position. |
| Key words: pneumoperitoneum position lower esophageal pH gastric regurgitation and aspiration |
