腹腔镜胆囊切除术对老年冠心病患者心肌酶和肌钙蛋白的影响

Effect of laparoscopic cholecystectomy on myocardial enzyme and cardiactroponin T of elderly patients with gallbladder stone and coronary heart disease

目的探讨腹腔镜胆囊切除术手术(LC)对老年胆囊疾病合并冠心病患者心肌损害的影响。方法选择31例老年胆囊结石合并冠心病患者采用自身对照分别于术前、手术开始30min、术后10min、术后2h、术后12h测定血气分析、肌磷酸激酶(CK)、乳酸脱氢酶(LDH)、心肌肌钙蛋白T(cTn-T)的变化。结果手术开始30min PaCO2明显升高,pH明显下降,与术前相比差异有统计学意义(P<0·05),术后10min PaCO2明显下降,pH恢复正常。手术开始30min CK、LDH逐渐升高,与术前相比差异有统计学意义(P<0·05);cTn-T术中、术后均有所升高,但数值较低,与术前相比差异无统计学意义(P>0·05)。结论老年胆囊结石合并冠心病患者在LC术中、术后,心肌无明显损害表现,但术中需加强血流动力学、血氧饱和度等指标的监测。

Objective To evaluate the effect of laparoscopic cholecystectomy on myocardial enzyme and cantiactroponin T of elderly patients with coronary heart diastase. Methods 31 ederly patients with gallbladder stone and coronary heart disease were tested the index of blood gas analyse, CK, LDH , cTn-T preoperation, 30 min in operation, 10 min postoperation and 2 h postoperation, 12 h postoperation. Results Patient＇ PaCO2 was increased significantly and pH decreased significantly in 30 min in operation（ P 〈 0.05）, PaCO2 was decreased and pH turned to normal in 10 min postoperation. CK,LDH ,cTn-T were increased during operation and 10 min postoperation, but cTn-T was no significant change（ P 〉 0.05）. Conclusion There is no obvious myocardial injury during and post LC in ederly patients with gallbldder stone and coronary heart disease, but need to carefully manage the hemodynamics,oxygen saturation of the patient＇s during operation.