腹腔镜手术方式和体位对老年病人呼吸循环的影响及护理

Influence of laparoscopic surgical approach and postural on respiratory cycle of older patients and nursing care of it

[目的]探讨不同腹腔镜手术方式和体位对老年病人呼吸循环的影响及护理。[方法]选择60岁以上、ASAⅠ级或ASAⅡ级腹腔镜手术病人90例,分为3组,每组30例。A组为仰卧头高足低位,B组为仰卧头低足高位,C组为侧卧位。监测病人气腹前后不同时间点[安置体位后气腹前5min(T0)、气腹后10 min(T1)、气腹后30 min(T2)、气腹后60min(T3)]的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、动脉血二氧化碳分压(PaCO2)、呼吸末二氧化碳分压(PET CO2)、气道峰压(Ppeqk)。[结果]3组HR均有减慢趋势,HR、SpO2各时间点比较差异无统计学意义。3组MAP气腹后升高,A、B两组在T1和T2时点与T0比较差异有统计学意义(P<0.05)。B组在T1,T2,T3时点PaCO2,PET CO2,Ppeak高于A组与C组(P<0.05)。组内比较在T1,T2,T3时PaCO2,PET CO2均较T0时明显升高。B、C两组Ppeak在T1,T2,T3时点均较T0显著升高(P<0.05)。[结论]3种腹腔镜手术方式和体位对心率的影响相似,下腹部手术血压影响程度大于上腹部手术,气腹时间延长及压力增加直接影响呼吸各参数值的变化,头低足高位对呼吸功能影响尤显突出。建议老年病人使用低CO2气腹压力为宜。

Objective：To probe into the influences and nursing care of differ- ent ways of laparoscopic surgery and different positions on respiratory and circulatory of elderly patients. Methods：A total of 90 cases of 60 years of age or older patients undergoing ASA I level or ASA 1I level laparoscopic sur- gery were divided into 3 groups,30 cases in each group. Patients in A group were in head high foot low supine, patients in B group were in head low foot high supine, patients in C group were in lateral position. Monitoring heart rate （HR）, mean arterial pressure （MAP）, saturation of pulse oximetry （SpO2）, arterial blood carbon dioxide（PaCO2 ）, breathing at the end of the carbon dioxide（PET CO2）, the airway peak pressure（Ppeqk）of different time points between before and after pneumoperitoneum[5 minutes after arrange for position and before pneumoperitoneum（T0 ）,10 minutes after pneumoper- itoneum （T1）, 30 minutes after pneumoperitoneum （T2）, 60 minutes after pneumoperitoneum（T3）]. Results： HR of patients in all 3 groups had the trend of slow down, and there was no statistically significant difference in HR and SpO2 among all time points. MAP of 3 groups rose after pneumo- peritoneum, there were statistically significant differences in MAP in T1 ,T2 time points compared with To time points between A group and B group（P〈0. 05）, PaCO2 ,PETCO2 ,Ppeak of B group were higher than that of A and C groups in T1 ,T2 ,T3 time points（P〈0.05）, the PaCO2, PETCO2 were significantly higher in T1 , T2 ,T3 time points compared with that in To time points inside each group. Ppeak was significantly higher in T1 ,T2 ,T3 time points in B and C two groups compared with that in To time points（P〈0. 05）. Conclusion：The in- fluence of 3 ways of laparoscopic surgery and different positions on HR was similar, the influence of blood pressure under abdominal surgery was greater than that of the upper abdominal surgery, prolonged pneumoperitoneum time and increased pressure directly affect the changes of respiratory varia- tion of each parameter value, and the influence of trendelenburg on respira- tory function is particularly prominent. It suggests that it is appropriate to use low CO2 of pneumoperitoneum pressure for elderly patients.