达芬奇机器人手术中长时间二氧化碳气腹对老年人QT离散度的影响

The effect of long-time carbon dioxide pneumoperitoneum on QT dispersion in elderly patients during Davinci robot-assisted surgery

目的观察达芬奇机器人手术中长时间二氧化碳（CO2）气腹对老年人QT离散度（QTd）的影响。方法选择择期行达芬奇机器人肝、胆、胰手术患者30例，全身麻醉，气腹压12mmHg（1mmHg=0．133kPa），气腹时间大于240min。记录并分析麻醉前，气腹后5、15、30、60、120、180、240min时的基本监测指标及QTd的变化。结果与麻醉前比较，气腹后15、30min时平均动脉压（MAP）显著升高（P〈0．05），而气腹后5、60、120、180、240min时变化差异无统计学意义（P〉0．05）；心率（HR）仅在气腹后15、30min时显著升高（P〈0．05），其余时间变化差异无统计学意义（P〉0．05）；呼气末二氧化碳分压（PEICO2）在气腹后呈上升趋势，气腹后30min开始比气腹后5min显著升高（P〈0．05）。30例患者中11例有房性期前收缩、室性期前收缩、心动过速等心律失常发生。与麻醉前比较，QTd、校正QT离散度（QTcd）、QT间期、校正QT间期（QTe）在气腹后15、30、60min时均显著增加（P〈0．05），而在气腹后5、120、180、240min时变化差异无统计学意义（P〉0．05）。结论达芬奇机器人手术中CO2气腹可引起心脏交感神经活性升高，导致心脏电生理改变，增加心血管事件发生率，尤其对老年人更应引起足够的重视。

Objective To study the effect of long-time carbon dioxide （CO2） pneumoperitoneum on QT dispersion （QTd） in elderly patients during Davinci robotassisted surgery. Methods Thirty elderly patients undergoing elective Davinci robot-assisted hepato-pancreato-biliary surgery with general anesthesia were enrolled in this study. Pneumoperitoneum was established at 12 mm Hg （ 1 mm Hg = 0.133 kPa）. QTd was recorded before the induction of anesthesia; at 5, 15, 30, 60, 120, 180 and 240 min after pneumoperitoneum. Results Compared with before anesthesia, mean arterial blood pressure （MAP） increased significantly at 15, 30 min after pneumoperitoneum （P 〈 0.05 ）, and had no significant difference at 5,60,120,180,240 min （P 〉 0.05 ）. Heart rate （HR） increased significantly at 15,30 rain after pneumoperitoneum （P 〈 0.05 ）. End-tidal pressure of carbon dioxide （PETCO2） increased after pneumoperi-toneum, and had significant difference at 30,60,120,180,240 min after pneumoperitoneum （P 〈0.05）. In 30 patients, 11 patients occurred arrhythmia including atrial extrasystole, premature ventricular beats, tachycardia. Compared with before anesthesia, QTd, corrected QTd （QTcd）, QT interval, corrected QT interval （QTc） were significantly increased at 15,30,60 min after pneumoperitoneum （P 〈 0.05）,but had on significant difference at 5,120,180,240minafterpneumoperitoneum （P〉0.05）. Conclusion The effect of CO2 pneumoperitoneum on the autonomie nervous system for elderly patients might be important, as an imbalance in autonomic cardiac control might lead to serious consequences.