Page 83 - 南京医科大学自然版

第44卷第6期 孔秋月，刘 洋，李 楠，等. 经皮二氧化碳测量在腹膜后腹腔镜泌尿外科手术中的准确性：
2024年6月 一项前瞻性观察性研究［J］. 南京医科大学学报（自然科学版），2024，44（6）：818-825 ·819 ·

3.18 to 10.48 mmHg. Conclusion：PTCCO2 monitoring improves the accuracy of estimating P aCO2 in patients undergoing
retroperitoneoscopic urologic surgery.
［Key words］ transcutaneous carbon dioxide；retroperitoneoscopic；urologic surgery；blood gas monitoring；end⁃tidal carbon dioxide
［J Nanjing Med Univ，2024，44（06）：818⁃825］

Retroperitoneal laparoscopic（RPL）surgery，utiliz⁃ and retroperitoneal pneumoperitoneum. KADAM et
ing retroperitoneal carbon dioxide（CO2）insufflation，is al. ［3］ found that CO2 absorption does not depend on the
currently established as a safe and reliable technique route of surgery. They found no significant difference
for specific urologic procedures. Although arterial blood in CO2 absorption between laparoscopic and retroperi⁃
gas（ABG）remains the golden standard for monitoring toneal nephrectomy，with only subcutaneous emphyse⁃
arterial blood carbon dioxide partial pressure（PaCO2）， ma notably increasing CO 2 absorption. Similarly，NG et
［4］
it is invasive and lacks consistency. The frequent need al. suggested that retroperitoneoscopy does not exhib⁃
for ABG analysis also contributes significantly to iatro⁃ it higher CO2 absorption compared to transperitoneal
genic anemia，particularly in critically ill patients and laparoscopy for renal or adrenal surgeries. However，in
［5］
infants. STREICH et al.’s study ，they discovered that the ret⁃
End⁃tidal carbon dioxide（PETCO2）is a commonly roperitoneal approach results in greater CO 2 absorption
used noninvasive method for predicting P aCO2 in me⁃ than intraperitoneal insufflation in urologic surgeries.
chanical ventilated patients. However，the accuracy of Given this inconsistency，the aim of this study
PETCO2 can be influenced by various factors such as sur⁃ was to investigate the accuracy of two distinct CO 2 par⁃
gical position，as well as severe cardiovascular or pul⁃ tial pressure monitoring techniques（PTCCO2 and PETCO2）
monary diseases. Another noninvasive method for mon⁃ and their correlation with P aCO2 in patients undergoing
itoring CO2 partial pressure is transcutaneous carbon retroperitoneoscopic surgery.
dioxide partial pressure（PTCCO2）. This method has
1 Materials and methods
been widely accepted and is reported to provide better
accuracy in predicting P aCO2 compared to PETCO2 under 1.1 Materials
many circumstances during laparoscopic surgery. In a This prospective observational study received ap⁃
［1］
study by XUE et al. ，in patients undergoing pro⁃ proval from the Institutional Ethics Committee of the
longed pneumoperitoneum laparoscopic surgery，88% First Affiliated Hospital of Nanjing Medical University
and 17% of the samples showed a clinically acceptable and was registered on www.ClinicalTrials.gov（NCT03
difference（ ≤ 5mmHg）between PTCCO2 ⁃ PaCO2 and 226041）. Initially，patients who were classified as the
PETCO2⁃PaCO2，respectively. American Society of Anesthesiologists（ASA）Ⅰ-Ⅲ and
Retroperitoneoscopic surgery，a minimally inva⁃ scheduled for retroperitoneoscopic urologic surgery
sive surgical technique used for treating urinary system were screened. Those with severe cardiovascular or re⁃
conditions，involves operating in the space behind the spiratory diseases，such as coronary heart disease，
peritoneal cavity，which is enclosed by the posterior ab⁃ chronic obstructive pulmonary disease（COPD），asth⁃
dominal wall. This area contains loose connective tis⁃ ma，a history of smoking or lung surgery（lobectomy or
sue and adipose tissue and spans from the neck to the simple wedge resection），and individuals with morbid
2
pelvis. During retroperitoneoscopic procedures，a surgi⁃ obese［body mass index（BMI）≥ 30 kg/m ］were ex⁃
cal cavity is created by separating the peritoneum and cluded. Subsequently，written consent was obtained
posterior abdominal wall. However，this blunt dissec⁃ from each participant before the surgery.
tion leads to significant surgical trauma，potentially re⁃ 1.2 Methods
sults in higher CO 2 absorption compared to intraperito⁃ 1.2.1 Sample size
［2］
neal laparoscopic techniques . Despite this，there is Based on our preliminary study，a sample size of
inconsistency in CO 2 absorption between intraperitoneal 45 achieves 90% power to detect a mean of paired dif⁃