开腹、气腹腹腔镜、无气腹腹腔镜结直肠癌手术对高龄患者术中心肺功能的影响

Effects of Open Surgery and Laparoscopy with or without Pneumoperitoneum on the Cardiopulmonary Functions of Elderly Patients with Colorectal Cancer

目的探讨开腹、气腹腹腔镜及腹壁悬吊腹腔镜结直肠癌手术对高龄高危患者的心肺功能的影响。方法选择我院普外科2008年2月～2010年1月收治的年龄≥60岁、合并高血压病或心脏基础疾病、NYHA心功能分级Ⅰ～Ⅱ级的拟行结直肠癌手术治疗者54例,根据患者意愿分为开腹组、气腹组及腹壁悬吊组。于麻醉前(T1)、气管插管后手术开始前(T2)及开腹、气腹或腹壁悬吊后10min(T3)、30min(T4)、60min(T5)、90min(T6)记录心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、中心静脉压(CVP)及气道峰压(PIP),T2及T4～T6行血气分析检查,记录pH、PaCO2等数值。结果气腹组1例更改手术方式为悬吊腹腔镜手术,为排除病例,余手术均顺利完成。气腹组在CO2气腹形成后DBP、CVP、PIP明显升高(P<0.01),随着手术时间的延长,气腹组逐渐出现动脉血pH降低(P>0.05)及PaCO2增高(P<0.01)。结论 CO2气腹的建立对心肺功能产生了较明显的影响。对于高龄高危患者,腹壁悬吊腹腔镜手术是一种较理想的手术方式。

Objective To investigate the cardiopulmonary functions of elderly patients during open surgery or laparoscopy with or without CO2 pneumoperitoneum for colorectal cancer.Methods Totally 54 patients（aged more than 60 years old）with colorectal cancer complicated with hypertension,or cardiac diseases（NYHA grade Ⅰ-Ⅱ）,who were admitted to our department from February 2008 to January 2010,were enrolled into this study.According to patients＇ choice,they were divided into open surgery,pneumoperitoneum,and abdominal wall lift groups.The HR,SBP,DBP,MAP,CVP,and PIP of the three groups were recorded before anesthesia（T1）,before the operation（T2）,and 10,30,60,and 90 min after opening the abdomen,pneumoperitoneum,or abdominal wall lifting（T3-T6）.At T2,and T4-T6,blood gas analysis were done as well.Results In the patients,one was transferred from pneumoperitoneum group into abdominal wall lift group during the surgery,and thus was excluded from this study.Operations were competed successfully in all the other patients.In the pneumoperitoneum group,DBP,CVP,and PIP increased significantly after CO2 pneumoperitoneum was established（P〈0.01）;blood gas analysis showed that the arterial pH decreased with operation time,while PaCO2 increased in this group（P〈0.01）.Conclusions CO2 pneumoperitoneum significantly influences cardiopulmonary functions of elderly patients,therefore,for patients at 60s or older,abdominal wall lifting is a good choice for laparoscopy.