Effects of pressure gradient controlon circulatory and respiratory function in early stage of carbon dioxide pneumoperitoneum in patients with gynecological laparoscopic surgery / 中国实用护理杂志

ABSTRACT

Objective:To investigate the effects of pressure gradient controlled carbon dioxide (CO 2) pneumoperitoneum establishment in patients with gynecological laparoscopic surgery on early circulatory and respiratory function. Methods:From November 1, 2018 to March 31,2019,100 case of gynecological laparoscopic surgery who were scheduled to undergo elective surgery in Jiangsu Hospital of Traditional Chinese Medicine were enrolled and divided into experimental group(50 cases) and control group(50 cases) by random number table method. The experimental group used pressure gradient control method to establish CO 2 pneumoperitoneum, that is, the pneumoperitoneum pressure was set to 5, 9, 12 mmHg(1 mmHg=0.133 kPa) gradually rising three gradients, and after reaching the corresponding gradient, they were maintained for 1 minute to 12 mmHg; the control group used conventional method, that was, the pneumoperitoneum pressure was set directly to 12 mmHg, and began to inflate until reaching the preset pressure. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), end-of-breath partial pressure of CO 2 (P ETCO 2), peak airway pressure (P peak), arterial blood partial pressure of CO 2 (PaCO 2) and the intervention of cirulation and respiration were compared between the two groups before and within 15 minutes after pneumoperitoneum. Results:The max values of SBP, DBP, MAP, HR, P ETCO 2, Ppeak and PaCO 2 within 15 minutes after pneumoperitoneum in the experimental group were (117.08±13.07) mmHg, (77.08±9.43) mmHg, (90.06±10.33) mmHg, (69.04±9.10) times/min, (36.00±3.37) mmHg, (20.18±2.74) cmH 2O(1 cmH 2O=0.098 kPa), (40.65±3.31) mmHg, higher than that of the control group (140.63±18.34) mmHg, (91.90±11.79) mmHg, (107.25±12.85) mmHg, (77.67±13.57) times/min, (38.31±4.31) mmHg, (24.81±4.26) cmH 2O, (45.19±4.49) mmHg, the differences were statistically significant( t values were-7.269--2.945, all P<0.01). The amplitudes of SBP, DBP, MAP, HR, P ETCO 2, Ppeak and PaCO 2 fluctuations before and after pneumoperitoneum in the experimental group were (10.14±6.34) mmHg, (8.98±5.88) mmHg, (9.14±5.44) mmHg, (5.80±2.48) times/min, (3.27±1.43) mmHg, (2.65±1.54) cmH2O, (4.08±1.74) mmHg, while the control group were (33.65±14.87) mmHg, (26.17±9.73) mmHg, (28.04±9.97) mmHg, (17.63±9.77) times/min, (6.98±2.89) mmHg, (7.44±2.35) cmH 2O, (9.52±3.92) mmHg, the differences were statistically significant( t values were -11.841--8.048, all P<0.01). Within 15 minutes after pneumoperitoneum, circulatory intervention was 4.08% (2/49) in the experimental group, lower than that in the control group 22.92% (11/48), the difference was statistically significant( χ2=7.412, P<0.01). Respiratory intervention in the experimental group was 0 (0/49), lower than that in the control group 10.42%(5/48), the difference was statistically significant(Fisher test, P<0.05). Conclusions:In gynecological laparoscopic surgery, using pressure gradient control method to establish CO 2 pneumoperitoneum is conducive to reducing the effect of early pneumoperitoneum on circulatory and respiratory function, maintaining the relative stability of circulatory and respiratory function, effectively reducing anesthesia-related interventions after circulatory and respiratory fluctuations, and is conducive to the safety of patients.