老年腹腔镜直结肠癌根治术中患者血流动力学的变化

Hemodynamic changes during laparoscopic colorectal surgery in elderly patients with USCOM

目的应用超声心排量监测仪(USCOM)观察老年患者行腹腔镜直结肠癌根治术术中血流动力学的变化。方法 25例ASAⅠ～Ⅲ级的腹腔镜直结肠癌根治术患者,按年龄分为老年组(≥70岁)和非老年组(<70岁)。术中应用USCOM监测血流动力学指标,分别于诱导后麻醉状态平稳10min,术中气腹头低位后5、15、30、60和90min以及气腹结束平卧位15min记录两组患者的心率(HR),平均动脉压(MAP),每搏输出量指数(SVI),心指数(CI),外周血管阻力(SVR),峰值流速(Vpk)和呼气末CO2分压(PetCO2)。结果气腹头低位改变后,两组HR均呈下降趋势,老年组在气腹结束后心率波动较大;两组MAP在气腹后显著升高,气腹结束后均未恢复。气腹后SVR老年组明显上升,气腹结束未下降;非老年组SVR在气腹建立初期上升,随即逐渐回落。两组SVI均上升,老年组气腹结束后未恢复,非老年组SVI气腹后期升高,气腹结束恢复。两组CI气腹过程无明显变化,老年组CI在T1、T2和T5较非老年组高(P<0.05);老年组Vpk在气腹头低后5min下降,随后恢复基础值,非老年组无明显变化。结论腹腔镜直结肠癌根治术中,气腹及体位变化对老年组的血流动力学影响明显且持久。

Objective To evaluate the changes of hemodynamics during laparoscopic colorectal surgery in elder patients with the ultrasonic cardiac output monitoring （USCOM）. Methods Twenty five ASA Ⅰ-Ⅲpatients undergoing elective laparoscopic colorectal surgery were divided into eider group （age ≥ 70 years） and non-elder group （age〈70 years）. Data of HR, SBP, DBP, MAP, Vpk, SV, SVI, CO, CI, SVR and PetCO2 in several time points were recorded. Results HR decreased after insufflation in both groups, but recovered after desufflation in non-elder group. HR in the elder group de- creased more significant at the end of insufflation. SVI increased after insuttlation in both groups, and SVI was recovered to the baseline after desufflation in non-elder group. But SVI in elder group did not recover to baseline after desufflation. Compared with corresponding parameters before insufflations, CI remained unchanged while MAP and SVR increased sig- nificantly after insufflation （P 〈 0.05） in the two groups. Most hymodynamie index in both groups recovered after desuffla- tion and back to supine. Conclusion The changes of hemodynamies during laparoscopic colorectal surgery in elderly pa- tients are more prominent and prolonged than the non-elderly patients.