本文選題：麻醉 + 高碳酸血癥�。� 參考：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的探討允許性高碳酸血癥對(duì)腹腔鏡全子宮切除手術(shù)的應(yīng)用價(jià)值及對(duì)患者IL-6、IL-10及TNF-a的影響。方法將46例擇期行腹腔鏡全子宮切除術(shù)患者隨機(jī)分為對(duì)照組(C組,23例)和允許性高碳酸血癥組(P組,23例)。兩組全麻誘導(dǎo)后,通過(guò)動(dòng)脈血?dú)饨Y(jié)果調(diào)整機(jī)械通氣參數(shù),P組PaCO2維持在45～60mmHg,pH值維持在7.25-7.35之間；對(duì)照組維持PaCO2維持在35～45mmHg,pH值維持在7.35-7.45之間。記錄To(麻醉前)、T1(麻醉誘導(dǎo)后)、T2(氣腹0.5小時(shí))、T3(氣腹1小時(shí))、T4(氣腹2小時(shí))、T5(結(jié)束氣腹0.5小時(shí))、T6(結(jié)束氣腹1小時(shí))時(shí)間點(diǎn)血壓、心率、血?dú)夥治?并測(cè)定IL-6、IL-10及TNF-α濃度。結(jié)果兩組病人年齡、體重、氣腹時(shí)間、手術(shù)時(shí)間及拔管時(shí)間比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；C組在T5、T6時(shí)點(diǎn)的平均動(dòng)脈壓明顯比P組高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),P組T2時(shí)點(diǎn)的心率較P組高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；P組T2～T6時(shí)IL-6和TNF-α均低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05或P0.01),兩組IL-10差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論允許性高碳酸血癥下行腹腔鏡全子宮切除術(shù),IL-6、 TNF-α均低于正常通氣組,提示這種通氣方式可能適合此類(lèi)手術(shù)的麻醉維持。
[Abstract]:Objective to investigate the value of permissive hypercapnia in laparoscopic hysterectomy and its effect on IL-6 IL-10 and TNF-a. Methods 46 patients undergoing laparoscopic hysterectomy were randomly divided into control group (n = 23) and permitted hypercapnia group (n = 23). After induction of general anesthesia, the parameters of mechanical ventilation were adjusted by arterial blood gas. The pH value of PaCO2 in group P was maintained between 7.25 and 7.35 in group P and the pH value of PaCO2 in control group was between 7.35 and 7.45 mm. The blood pressure, heart rate and blood gas were recorded at the time point of ToT _ 1 (after induction of anesthesia), and the concentrations of IL-10 and TNF- 偽 were measured. Results there was no significant difference in age, body weight, pneumoperitoneum time, operation time and extubation time between the two groups. The mean arterial pressure at T5 / T6 in group C was significantly higher than that in group P, and the heart rate in group P was significantly higher than that in group P at T2. The difference of IL-6 and TNF- 偽 in T2~T6 group was significantly lower than that in control group (P 0.05 or P 0.01). There was no significant difference in IL-10 between the two groups (P 0.05). Conclusion the levels of IL-6 and TNF- 偽 in laparoscopic total hysterectomy under permissive hypercapnia are lower than those in normal ventilation group, suggesting that this ventilation may be suitable for anesthesia maintenance.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R614

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