Effects Of Different Tidal Volume On P_ETCO₂ And Endocrine At Performing Of Pneumoperitoneum During Gynaecologica Laparoscopy Anesthesia

[Objective] To study the effect of different Tidal Volume on PETCO2,BP,HR and corticosteroid during Gynaecologica Laparoscopy Anesthesia.[Methods] One hundred ASAⅠ～Ⅱpatients,ages range from 28 to 62, weight range from 42 to 76kg,undergoing selective Endoscopy Opration were enrolled in the study. The patients were randomly divided into 5 groups:group A (Tidal Volume 7ml/kg),group B (Tidal Volume 8ml/kg),group C (Tidal Volume 10ml/kg),D (Tidal Volume 12ml/kg)and group E(Tidal Volume 13ml/kg), which contained 20 cases respectively. The time of fasting solid was more than 12 hours and fluid was more than 4 hours.Atropine 0.5mg was intramascular injected at 30 minutes before operation. After opening the venous channel, Ringer lactate solution and 6% hydroxyethyl starch with the proportion of two to one were infused. Alltheinduction of anesthesiawere:midazolam 0.05～0.10mg/kg, fentany 12～3ug/kg,etomidate 3mg/kg, vecuronium0.08～0.12mg/kg.Afterintubation,1%～2.5%isoflurane,2.0～2.5 ug/(kg-min) propofol (TCI), vecuronium 1.00～1.70mg/(kg-min) and remifentanil 0.01-0.1ug/kg/min were to maint ainanesthesia.Set up artificial pneumoperitone,the umabdominal pressure was 10～15cmH2O.The blood pressure (BP),heart rate (HR),electrocardiogram (ECG) and blood oxygen saturation (SPO2) of all patients were recorded successive during the surgery.In five groups,the SBP,DBP,HR/SpO2 and PETCO2 were recored at time points:(1) the time of 5min before pneumoperitoneum (T1), the time of 15min after pneumoperitoneum (T2),the time of 30min after pneumoperitoneum (T3) and the time of 50 min after pneumoperitoneum (T4).(2) Observe the relationship of Tidal Volume and PETCO2.(3)The change of corticosteroid in five groups were recored before pneumoperitoneum(T1) and after pneumoperitoneum(T3). (4) At the same time, recoreded the corticosteroid of 20 open surgery patients(tidel volume 7ml/kg, the method of anesthesia was same as the other five groups) at before anesthesia (TIA) and 30 min after operation (T3A) for easy to compare.[Results](1) MAP:As compared with before anesthesia, MAP raised up apparently in group A and B at T2,T3,T4; The change in group C raised up apparently at T2 and T3, in group D and E at T2,there were statistically significant (P<0.05); (2) HR:As compared with before anesthesia, HR raised up apparently in group A at T2,T3,T4; The change in group B raised up apparently at T2 and T3, in group D and E at T2,there were statistically significant (P<0.05); (3) PETCO2:As compared with before anesthesia, PETCO2 raised up apparently and at a high level than normal range in group A at T2,T3,T4 (P<0.05); In group B, PETCO2 at T3 and T4 increased obviously(P < 0.05),T4 was moreover than normal range (P<0.05);In group C, The PETCO2 at T4 increased obviously(P<0.05) but there was no statistically significant compare to the normal range(P> 0.05); As compared with before anesthesia in group E decreased obviously at T3 and T4(P< 0.05), nevertheless,there were statistically significant compare to the normal range(P< 0.05).(4) Comparison among the each groups, the corticosteroid in five groups increased obviously at T3 with before anesthesia(P<0.05), there were no statistically significant(P> 0.05); Compared with open group, the corticosteroid in other five groups were apparently decreased, there were statistically significant (P<0.05)[Conclusion] (1) During anesthesia in laparoscopic operation,tidal Volume 8～12 ml/kg can maintain PETCO2 into a normal range; (2) The stress response in laparoscopic operation is smaller than the patients undergoing open surgery. The degree of stress response during laparoscopic operation is no related with the different tide volumes.