比较腹腔镜胆囊切除术气腹压力对老年与年轻患者血流动力学的影响  

Effects of pneumoperitoneal pressure on hemodynamics in elderly and young patients during laparoscopic cholecystectomy

作　　者：曹春芳[1] 张凡[1] 周燕[1] 袁岩[1] 

机构地区：[1]江苏省常州市第一人民医院麻醉科,213003

出　　处：《临床麻醉学杂志》2012年第11期1073-1075,共3页Journal of Clinical Anesthesiology

摘　　要：目的比较腹腔镜胆囊切除术中气腹压力对老人及年轻人血流动力学的影响。方法 40例ASAⅠ或Ⅱ级择期行腹腔镜胆囊切除术的患者,其中20例20～45岁(Y组),20例65～75岁(L组),两组患者均采用同一全凭静脉麻醉方法,气腹压力设置为12mmHg。应用LIFE-GARDTMICG监测仪,进行血流动力学评估。分别记录气腹前5min(T0)、气腹后5min(T1)、10min(T2)、放气后5min(T3)的HR、MAP、心脏指数(CI)、外周血管阻力(SVR)。结果与T0时比较,T1、T2时两组MAP、SVR均显著升高(P<0.01),CI均明显下降(P<0.01),T3时两组MAP、CI、SVR、HR恢复到T0时;T1、T2时L组HR明显快于,CI明显低于,MAP及SVR明显高于Y组(P<0.05)。结论腹腔镜胆囊切除术中同样的气腹压力对老年人血流动力学的影响更明显。Objective To compare pneumoperitoneal pressure on hemodynamic in elderly and young patients during laparoscopic cholecystectomy（LC）. Methods Forty ASA Ⅰ or Ⅱ patients scheduled for LC including 20 young patients（20-45 yr, group Y） and 20 elderly patients（65-75 yr, group L） received the same anesthesia method. Hemodynamic parameters were measured with LIFEGARDTMICG. HR, MAP, cardiac index （CI）, systemic vascular resistance（SVR）were recorded before pneumoperitoneum（T0 ）, 5 min after penumopetritoneum（T1 ）, 10 min after（T2 ）, 5 min after desufflation（T3）. Results In both groups, MAP, SVR increased, and CI decreased significantly after the beginning pneumoperitoneum （P 〈 0. 01 ）. After desufflation, all the hemodynamic parameters began to recover. Compared with group Y, MAP, SVR increased significantly, CI decreased significantly at T1 ,T2 in group L（P〈0. 05）. There was no significant difference in HR at each time point in group Y but HR increased significantly at T1, T2 in group L. Conclusion There are more pronounced hemodynamics changes in elderly patients than young patients under same pneumoperitoneal pressure during LC.

关 键 词：腹腔镜胆囊切除术 气腹 血流动力学 老年人 

分 类 号：R614[医药卫生—麻醉学]