腹腔镜CO_2气腹对老年人酸碱平衡与创伤应激反应的影响  

Influence of CO2 pneumoperitoneum on acid-base equilibrium and stress reaction of elderly patients during laparoscopic operation

作　　者：韩策然[1] 刘兆龙[1] 阎波[1] 

机构地区：[1]上海市浦东新区人民医院,上海201200

出　　处：《腹腔镜外科杂志》2012年第10期731-734,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜CO2气腹对老年患者酸碱平衡及创伤应激反应的影响。方法:将60例65岁以上老年患者分为两组,其中30例行腹腔镜手术(腹腔镜组),30例行传统开腹手术(开腹组)。分别于手术前、术终、术后12 h、术后24 h抽动脉血检测血气分析pH、PO2、PCO2、HCO3-、BE及电解质K+的水平;同时采集静脉血分别测定血浆皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)浓度。结果:术终及术后12 h,两组患者pH、PCO2、HCO3-、BE值差异均有统计学意义(P<0.05),PO2值无明显变化(P>0.05)。与术前相比,腹腔镜组术终、术后12 h pH、PCO2、HCO3-、BE值差异均有统计学意义(P<0.05),PO2无显著变化(P>0.05);术后24 h两组患者pH、PO2、PCO2、HCO3-、BE无显著变化(P>0.05)。腹腔镜组术终K+升高;术后12 h后与术前相比,两组均无显著变化(P>0.05)。腹腔镜手术CO2气腹可使老年患者血中pH值下降,PCO2上升、高碳酸血症;K+升高,术后12 h内达高峰,24 h后多可代偿;其酸碱平衡的变化程度较有限,且与手术时间、术前是否合并心肺功能不全呈正相关。开腹组Cor、E、NE术后明显升高,差异有统计学意义(P<0.05);腹腔镜组无显著变化(P>0.05)。结论:在创伤应激反应方面,腹腔镜手术较开腹手术具有明显优越性。虽然腹腔镜手术CO2气腹对老年患者酸碱平衡有一定影响,但患者多可耐受。如合并较严重心肺系统疾病,可引起严重后果。因此,术前心肺功能风险评估、积极治疗与改善心肺功能,术中降低气腹压力、控制手术时间,术后血气监测、及时处理十分重要。Objective：To investigate the effect of CO2 pneumoperitoneum on acid-base equilibrium and stress response of old patients during laparoscopic operation.Methods：Sixty patients（≥65 years old） were randomly divided into the laparoscopic operation group（30 cases） and the open operation group（30 cases）.These values of pH,PO2,PCO2,HCO3-,BE and the dielectric medium K＋ level were detected by arterial blood gas analysis at pre-operation,0,12,24 h of post-operation.These concentration including cortex（Cor）,epinephrine（E） and norepinephrine（NE） were analyzed by collection of venous blood.Results：These values of pH,PCO2,HCO3-,BE displayed significantly different between laparoscopic operation and open operation group at post-operation and 12 h of post-operation（P0.05）.In addition,at 24 h of post-operation,these above value haven’t changed between laparoscopic operation and open operation group,and there was no change compared with pre-operation in laparoscopic operation or open operation group（P〉0.05）.The concentration of K＋ was elevated in post-laparoscopic operation group,whereas,there was no change at 12 h of post-operation between laparoscopic operation and open operation group or the same group（P〉0.05）.In laparoscopic operation group,CO2 pneumoperitoneum resulted in a decrease in the value of pH,an increase in the level of PCO2,and hypercarbia.The concentration of K＋ was raised and reach a peak at 12 h of post-operation,which was compensated after 24 h of post-operation.But its acid-base equilibrium’s change degree is limited,which is positively related with the surgery time and whether combined heart and lung failure.For injure stress response,the values of Cor,E,NE have a remarkable significance in open operation at the post-operation,12 h of post-operation and 24 h of post-operation compared with laparoscopic operation group（P0.05）.Conclusions：In general,laparoscopic operation showed significant superiority to open operation in stress response.Although C

关 键 词：腹腔镜手术 CO2气腹 酸碱平衡 应激反应 

分 类 号：R656[医药卫生—外科学]