老年患者经皮肾镜碎石术中呼吸和循环功能的变化  

Changes of respiratory and circulatory function of elderly patients undergoing percutaneous nephrolithotomy

作　　者：曾涟[1] 莫浪平[1] 阳丽云[1] 韦雄丽[1] 

机构地区：[1]广西医科大学第一附属医院麻醉科,南宁530021

出　　处：《右江医学》2014年第3期320-323,共4页Chinese Youjiang Medical Journal

摘　　要：目的观察老年患者全身麻醉下俯卧位经皮肾镜碎石术中呼吸功能和循环功能的变化。方法随机选择全身麻醉经皮肾镜碎石术的老年患者50例,年龄≥65岁,灌注碎石时间范围60～120min。所有患者采用统一的麻醉方法和手术方式。患者入手术室后监测记录MAP、HR、PaO2、CVP,麻醉诱导后监测Ppeak;以麻醉诱导前（T0）、截石位后5min（T1）、俯卧位后5min（T2）、灌注碎石30min（T3）、灌注碎石60min（T4）、灌注碎石术毕（T5）为监测时点,在T0～T5时间点行动脉血气分析,记录pH值、BE、PaCO2、PaO2和血清Na＋、K＋、Cl-的浓度,根据公式计算肺泡-动脉血氧分压差。结果 T1～T5PaO2呈下降趋势,在T4、T5时点降低明显,与T1、T2比较差异有统计学意义（P〈0.05）;pH、BE在T4和T5下降,与T0比较差异有统计学意义（P〈0.05或〈0.01）;K＋在T4和T5下降,与T0比较差异有统计学意义（P〈0.01）;MAP在T2时点下降,与T1比较差异有统计学意义（P〈0.01）。俯卧位后患者的CVP和Ppeak升高,在灌注碎石期间呈升高趋势,在T4、T5时点与俯卧位后（T2）比较差异有统计学意义（P〈0.05或0.01）。PaCO2、HR、Na＋、Cl-各时点相互比较差异无统计学意义。结论老年患者全麻下俯卧位行经皮肾镜碎石术中呼吸功能和循环功能变化较小,但有必要加强术中麻醉监测并控制手术时间。Objective To investigate the changes of respiratory and circulation function of elderly patients undergo ing percutaneous nephrolithotomy with prone position under general anesthesia.Methods 50 cases of elderly patients aged or older than 65 undergoing percutaneous nephrolithotomy under general anesthesia were selected with time range of gravel perfusion from 60 to 120 mins.All of the patients were given the same anesthesia and surgery. After patients entered into the operating room, MAP, HR, SPO2, CVP of all the patients were monitored and Ppeak was monitored after induction of anesthesia.Monitoring points included：before anesthesia induction（T0 ）, 5 min after lithot- omy position（T1 ）, 5 min after the prone position（T2 ）, 30 rain after lithotripsy（T3 ）, 60 min after lithotripsy （T4） and lithotripsy finished（T5 ）.At To ～T5 points,arterial blood gas was analysed and pH value, BE, PaCO2, PaO2 and concentration of serum sodium （Na＋ ）, potassium （K＋ ）, serum chloride （CI-） were recorded. Alveolar-arterial difference of blood oxygen pressure was calculated by formula.Results SpO2 at T1～T5 declined and it decreased obviously at T4 and T5.Compared with that at T1 and T2 ,difference of such change at T4 and T5 was statistically significant （ P % 0.05）.pH and BE significantly decreased at T4 and T5 ,which was statistically significantly different from the change at To（ P〈0.05 or 〈0.01）.K＋ at T4 and Ts decreased,which was also significantly different from that at To（ P 〈0.01）.MAP decreased at T2 .Compared with the change at T1 ,the difference was statistically significant （ P 〈0.05 or〈 0.01）.Patients＇ CVP and Ppeak increased after prone position and they had a tendency of increase during lithotripsy. Compared with those at T2, CVP and Ppeak at T4 and T4 was statistically significantly different（ P〈0.01）.Therewas not significant statistical difference in PaC02, HR,Na＋ and C1 PaCO2 at different time points.Conclusion Percu- taneous nephrolit

关 键 词：老年人 经皮肾镜碎石术 呼吸功能 循环功能 

分 类 号：R699[医药卫生—泌尿科学]