腹腔镜阑尾切除术CO_2气腹对老年急性阑尾炎患者眼内压及循环系统的影响

Effect of laparoscopic appendectomy with CO_2 pneumoperitoneum on intraocular pressure and circulatory system in elderly patients with acute appendicitis

目的:探究腹腔镜阑尾切除术CO_2气腹对老年急性阑尾炎患者眼内压及循环系统的影响。方法:选取手术治疗的86例老年急性阑尾炎患者为研究对象,按照随机数字表法将其均分为实验组和对照组,每组各43例患者,对照组患者实施腹腔镜下CO_2气腹手术,实验组患者实施无气腹压力手术。选取术前(T_0)、开腹或气腹10min(T_1)、开腹或气腹30min(T_2)三个时间点,对比两组患者三个时间点的心率(HR)、平均动脉压差(MAP)、中心静脉压(CVP)、眼内压(IOP),使用简易智力状态检查量表(MMSE)对两组患者术前、手术结束1h及术后1d的认知功能进行对比分析。结果:(1)T_0时两组患者的HR、MAP及CVP对比差异不具有统计学意义(P>0.05),T_1及T_2时,对照组患者HR、MAP及CVP明显高于实验组患者(P<0.05);(2)T_0时两组患者IOP对比差异不具有统计学意义(P>0.05),T_1及T_2时,对照组患者IOP明显高于实验组患者(P<0.05);(3)术前及术后1d两组患者MMSE得分对比差异不具有统计学意义(P>0.05),术后1h实验组患者MMSE得分高于对照组(P<0.05)。结论:腹腔镜阑尾切除术CO_2气腹状态会对老年急性阑尾炎患者的循环系统及眼压产生较大的影响,应加强术中对患者生命体征的监测,同时应综合考虑老年急性阑尾炎患者手术方式。

ObjectiveTo explore the effect of CO 2 pneumoperitoneum on intraocular pressure and circulatory system in elderly patients with acute appendicitis.Methods： 86 elderly patients with acute appendicitis were selected and divided into experimental group and control group according to the random digital table method. 43 patients in each group were treated with laparoscopic CO 2 pneumoperitoneum operation. The patients in the experimental group were operated on without pneumoperitoneum. Three time points of preoperative （T 0 ）, open or pneumoperitoneum 10min （T 1 ）, laparotomy or pneumoperitoneum 30min （T 2 ） were selected, and the heart rate （HR）, mean arterial pressure difference （MAP）, central venous pressure （CVP） and intraocular pressure （IOP） were compared between the two groups at 3 time points, and the simple mental state examination scale （MMSE） was used for the pre operation of the two groups of patients. The cognitive function of 1h after operation and 1 d after operation were compared and analyzed.Results：①The differences of HR, MAP and CVP in the two groups were not statistically significant （ P 〉0.05）, while T 1 and T 2 , HR, MAP and CVP in the control group were significantly higher than those of the experimental group （ P 〈0.05）; ②The contrast difference between the two groups was not statistically significant （ P 〉0.05）. It was significantly higher than the experimental group （ P 〈0.05）; ③There was no statistical difference between the 1 d two groups before and after the operation （ P 〉0.05）, and the scores of MMSE in the 1 h experimental group were higher than those in the control group （ P 〈0.05）.Conclusion：The CO 2 pneumoperitoneum of laparoscopic appendectomy will have a great influence on the circulatory system and intraocular pressure of the elderly patients with acute appendicitis. It is necessary to strengthen the monitoring of the vital signs of the patients during the operation, and should consider the operation mode of the elderly patients with acute appendicitis.