腹腔镜胆囊切除二氧化碳气腹对中、老年患者呼吸及循环的影响

Clinic research about effect of carbon dioxide pneumoperitoneum on circulation and respiratory system during LC in middle-aged and old

目的研究腹腔胆囊切除术中二氧化碳气腹对中、老年患者呼吸及循环系统的影响。方法老年组患者51例(按气腹压力设定分为:A1组,12mmHg,16例;A2组,14mmHg,20例;A3组,16mmHg,15例),中年组患者18例(B组:压力设定为14mmHg)。观察A2组与B组气腹前10min、气腹后10min及术毕10min各项血气指标,观察A1、A2和A3组不同气腹压力下气腹前10min及气腹后10min各项血气指标变化。结果A2组和B组与气腹前比较:心率(HR)、收缩压(SBP)、舒张压(DBP)、呼气末二氧化碳值(PETCO2)和RRP明显上升(P<0.01),pH、最低血氧饱和度(SaO2)明显下降(P<0.01),术毕各项指标与气腹前比较差异无显著性。与B组比较,气腹前A2组各项指标较B组差异无显著性,气腹后HR、SBP、PETCO2和RRP明显偏高(P<0.01),DBP无明显变化,pH和SaO2明显偏低(P<0.01),与A1组比较,气腹后A2和A3组HR、SBP、PETCO2和RRP明显偏高(P<0.01),SaO2明显偏低(P<0.01)。结论腹腔镜胆囊切除术中二氧化碳气腹对老年患者呼吸、循环功能的影响较其对中年患者的影响更为明显,在12mmHg低气腹压力下行LC术,可显著降低气腹对老年患者生理功能的干扰。

[Objective] To assess the effect of carbon dioxide pneumoperitoneum on circulation and respiratory system during laparoscopic chelecysteclomy (LC) in middle-aged and old people. [Mehtod] 51 aged patients were prospectively divided into three groups: 16 patients (groupA1) underwent laparoscopic cholecystectomy (LC) with 12 mmHg of CO2, 20 patients (group A2) with 14 mmHg of CO2, 15 patients (group A3) with 16 mmHg of CO2, 18 middle-aged patients (groupB) underwent LC with 14 mmHg. The HR, SBP, PH, DBP, SaO2, PETCO2, RRP of group A2 and B were analyzed at different time: before insufflation, 10 minutes after insufflation, 10 minutes after operation. The HR, SBP, SaO2, PETCO2, RRP of group A1, A3 were analyed at 10 minutes before insufflation and 10 minutes after insufflation. [Result] The HR, SBP, DBP, PETCO2, RRP of group A2 and B in LC during the pertitioneal insufflations increased (P <0.01), whereas PH, SaO2 decreased obviously compared with preinsufflation (P <0.01), After deflation of peritoneal cavity, the parameters recovered to preinsufflation lever. There were no significant difference in all the parameters between group A2 and group B before insufflation. After insufflation HR, SBP, PETCO2, RRP of group A2 were much higher than group B(P <0.01), while PH, SaO2 were lower (P <0.01). There was no significant difference in DBP between group A2 and B after insufflation. After insufflation HR, SBP, PETCO2, RRP of group A2 and A3 were much higher than group A1(P<0.01), while SaO2 was lower(P<0.01). [Conclusion] Carbon dioxide pneumoperitoneum of laparoscopic cholecystectomy cause more significant changes in circulation and respiratory function on aged people than on the middle-aged. A 12 mmHg CO2 pneumoperitoneum helps to reduce the disturbance of physiological function on old aged people during LC.