二氧化碳气腹对老年人的血流动力学改变与血气影响

Effect of carbon dioxide pneumoperitoneum on hemodynamics and blood gas of geriatric patients.

目的 探讨二氧化碳气腹对心功能异常的老年人血流动力学和血气的影响。方法 将 6 0岁以上患胆囊疾病的老年人 ,合并心血管疾病和部分肺部疾病 ,心脏功能Ⅱ级 ,随机分为腹腔镜胆囊切除术组 (1 4例 )与剖腹组 (1 0例 )。用监测仪观察诱导前、术前及术后 5、1 0、1 5分钟和拔管后 5、1 0分钟的血流动力学和血气变化。结果 气腹后血压明显升高。 8例病人心率减慢 ,2例心律失常 ,均治愈。气腹后中心静脉压上升至拔管后 ,明显高于相应时间点的剖腹组。气腹后血液二氧化碳分压显著升高 ,血液 pH显著降低 ,与剖腹组有显著区别。 结论 有心功能异常的老年病人只要做好术前准备 。

Objective To study the effects of carbon dioxide (CO 2) pneumopertioneum on hemodynamics and blood gas of geriatric patients with abnormal cardiac function.Methods Elderly patients over 60 with cardiovascular disease and pulmonary disease and ASAⅡ were randomized into two groups:14 cases with laparoscopic cholecystectomy under CO 2 pneumoperitoneum and 10 cases under open cholecystectomy.Hemodynamics and blood gas were measured with DATEX CARDIOCAP and Ultima drawing artery blood before induction,insufflation or laparotomy,5 min,10 min or 15 min after insufflation or laparotomy,5 min or 10 min after extracting endotracheal tube.Results Blood pressure elevated significantly after insufflation of CO 2.8 cases had the reduced heart rate and 2 cases developed cardiac arrhythmia after the insufflation.These patients were cured immediately.Central venous pressure in the patients with laparoscopic cholecystectomy was higher than in the patients with open cholecystectomy between the beginning of operation and the ending of anesthesia.Serum CO 2 partial pressure in the patients increased after the insufflation and pH decreased when comparing with those in the patients with open cholecystectomy.There was no morbidity or mortality in the patients with laparoscopic cholecystectomy or open cholecystectomy.Conclusion It is proved that the laparoscopic cholecystectomy is safe and well done for the geriatric patients with abnormal cardiac function with careful preoperative preparations.