Clinical Observation On Different Intra-abdominal Pressure And Different Time Points During Gynecological Laparoscopic Operation

Objective: To observe the effect of different intra-abdominal pressure and different time points on hemodynamic , ent-tidal CO₂(P_etCO₂) and airway pressure(Paw) during the procedure of gynecological laparoscopic operation .Methods :60 cases underwent gynecological laparoscopic operation were randomly divided into two groups :30 cases of the intra-abdominal pressure was kept 1.3kpa(group I ) and the rest was kept 1.9kpa (group II ).ASA I grade .General preoperative medicine, after induction of anesthesia and intubation patients were continuous infused with Propofol 4 mg/kg/h , Norcuron 40ug/kg/h,Fentanyl 2ug/kg/h and inhaled Isoflurane continually to maintain anesthesia. To observe the intra-abdominal pressure of 1.3kpa or 1.9kpa. we monitored and recorded systolic blood pressure(SBP),diastolic blood pressure (DBP), mean arterial pressure(MAP),heart rates(HR),S-T ,Paw and P_etCO₂ before anesthesia(To), shortly after intubation(T₁) ,pre-pneumoperitoneum (T2) ,5min after pneumoperitoneum (supine position )(T₃) and 5min(T₄),10min(T₅),20min(T₆),30min(T₇) after Trendelenbury position(head down 20°)and 5 min after deflation(T₈) .Results :two groups patients DBP, MAP were increased significantly (p<0.05)after intubation. SBP, DBP, MAP at time point T₃ ,T₄ ,T₅ were increased significantly when compared with those of T₀ (p<0.01) .But extent of increase seemed to decrease, the blood pressure decreased from T₆ to defiation.Compared with that of To,HR was decreased and S-T increased Significantly (P<0.01) during pneumoperitoneum .But two grounds have no obvious changes. There were no Significant hemodynamic differences between the two groups in the same time point(P>0.05),there were Significant differences of Paw and P_etCO₂ within the same group and between the same time point of two groups after pneumoperitoneum. (P<0.01) conclusion: There were no Significant hemodynamic differences between intra-abdominal pressure 1.3kpa and 1.9kpa during gynecological laparoscopic operation ,but resulting in Significant differences in Paw and P_etCO₂ , So more attention should been paid to the monitor of respiratory during laparoscopic operation...