后腹腔镜术中降低气腹压力对老年患者呼吸循环的影响  

Effect of pneumoperitoneum pressure decrease on respiration and circulation of elderly patients undergoing retroperitoneoscopic operation

作　　者：孙琳婧[1] 杨拥军[2] 唐锦荣[1] 缪永辉[1] 仇惠斌 

机构地区：[1]江苏省南通市如东县人民医院麻醉科,226400 [2]江苏省南通市如东县人民医院泌尿外科,226400

出　　处：《临床麻醉学杂志》2012年第10期995-997,共3页Journal of Clinical Anesthesiology

摘　　要：目的评价后腹腔镜手术中降低CO2气腹压力对老年患者呼吸及循环的影响。方法择期行后腹腔镜下泌尿外科手术患者40例,年龄60～78岁,体重53～82kg,随机均分为两组:A组气腹压力14mmHg,VT12ml/kg,RR15次/分;B组气腹压力10～13mmHg,VT10ml/kg,RR12次/分;两组均维持PETCO2在35～45mmHg。监测并记录气腹(T0)、气腹后30min(T1)、气腹后60min(T2)、放气后10min(T3)。结果与T0时比较,T1、T2时两组HR明显增快;MAP、CVP、Pmax和PaCO2均明显升高(P<0.05);而pH明显降低(P<0.05)。与A组比较,B组T2、T3时CVP和T1～T3时Pmax均明显降低(P<0.05)。B组皮下气肿发生率明显低于A组(5%vs.30%,P<0.05)。结论后腹腔镜手术中降低气腹压力有助于降低对老年患者动脉血气和血流动力学的影响,并减少皮下气肿的发生率。Objective To investigate the effect of pneumoperitoneum pressure decrease on respiration and circulation of elderly patients undergoing retroperitoneoseopie operation. Methods Forty ASA I or n patients aged 60-78 years weighing 53-82 kg undergoing retroperitoneoscopic operation in urology surgery were randomly allocated into 2 groups （n = 20 each）： constant pneumoperitoneum pressure group （group A）; pneumoperitoneum pressure regulation group （group B）. The HR, mean arterial pressure （MAP）, central venous pressure （CVP）, and arterial carbon dioxide partial pressure （PaCO2） of patients in both groups were monitored and recorded before pneumoperitoneum （To） and 30 rain （T1）, 60 rain （T2） after pneumoperitoneum,and 10 rain after deflation（T3）. Results Compared with To, HR in both groups were faster and MAP, CVP, Pmax, PaCO2 were higher at T1, T2 （P〈0.05）, while pH were decreased significantly（P〈0.05）. Compared with group A, CVP at T2, T3 and Pmax at T1-T3 were all decrcased obviowshy in group B（P〈0.05）. The incidence rate of subcutaneous emphysema in group B were lower than in group A （5- vs. 30%, P〈0.05）. Conclusion Pneumoperitoneum pressure decrease conduces to cut down the incidence rate of subcutaneous emphysema and less influence to arterial blood gas and hemodynamic of elderly patients undergoing retroperitoneoscopic.

关 键 词：后腹腔镜手术 气腹 老年 血流动力学 

分 类 号：R736.6[医药卫生—肿瘤]