二氧化碳气腹在腹腔镜腹股沟疝修补手术中对心电图影响的前瞻性随机对照研究  

Effect of carbon dioxide pneumoperitoneum on electrocardiogram during laparoscopic inguinal hernia repair:A prospective randomized controlled study

作　　者：宋彬彬[1] 朱熠林[2] 杨继超[1] 陈杰[2] Song Binbin;Zhu Yilin;Yang Jichao;Chen Jie(Department of Electrocardiogram,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China;Department of Hernia and Abdominal Wall Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院心电图室,100043 [2]首都医科大学附属北京朝阳医院疝和腹壁外科,100043

出　　处：《中华疝和腹壁外科杂志（电子版）》2021年第2期199-202,共4页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的对比CO2气腹在腹腔镜经腹腹膜前疝修补术(TAPP)手术和腹腔镜完全腹膜外疝修补术(TEP)手术中对心电图的影响结果。方法收集2019年6至11月,首都医科大学附属北京朝阳医院疝和腹壁外科120例原发性腹股沟疝患者的临床资料。按照随机数表法分为TAPP组和TEP组,通过对比患者手术前后心电图情况及术中血流动力学改变,分析两种手术方式气腹对心电图的影响。结果TAPP组手术时间(45.2±12.33)min和TEP组(41.32±8.09)min比较,差异有统计学意义(P<0.05);TAPP组平均麻醉时间(58.4±12.11)min和TEP组(59.27±8.69)min比较,差异无统计学意义(P>0.05)。TAPP急性疼痛情况2例(3.33%),TEP组4例(6.67%),差异无统计学意义(P>0.05);2组患者术中均未出现并发症,如严重出血、输精管损伤、精索血管损伤、肠管或膀胱损伤等;在院期间2组患者未出现尿潴留、谵妄及静脉血栓等围手术期并发症。2组心电图异常发生率、术后心率和术后平均动脉压(MAP)比较,差异有统计学意义(P<0.05);2组术前心率和术前MAP比较,差异无统计学意义(P>0.05)。结论TEP手术在术中心电图影响方面较TAPP存在劣势,TEP手术可能会引起更多的心电图异常改变,需要严密监测。Objective To compare the effect of carbon dioxide(CO2)pneumoperitoneum on electrocardiogram(ECG)during laparoscopic transabdominal preperitoneal hernia repair(TAPP)and totally extraperitoneal hernia repair(TEP).Methods Clinical data of 120 patients with primary inguinal hernia in Beijing Chaoyanghospitalbetween June to November 2019 were collected.All patients were randomly divided into the TAPP group and the TEP group.By comparing the electrocardiogram situation of patients before and after operation and intraoperative hemodynamic changes,the influence of pneumoperitoneum on electrocardiogram of the two surgical methods was analyzed.Results The operation time of patients in TEP group was(41.32±8.09)minutes,shorter than that in TAPP group[(45.2±12.33)minutes],and the difference was significant(P<0.05).There was no statistically significant difference between the two groups in terms of anesthesia duration[(58.4±12.11)minutes vs(59.27±8.69)minutes,P>0.05].Acute pain occurred in 2 cases(3.33%)in TAPP group,and 4 cases(6.67%)in TEP group,without statistical significance(P>0.05).There were no intraoperative complications in both groups,such as severe bleeding,vas deferens injury,spermatic vessels injury,andintestinal or bladder injury.There were no perioperative complications in both groups,such as urinary retention,delirium and venous thrombosis.In terms of the abnormalities in electrocardiogram,postoperative heart rate(HR)and postoperative mean arterial pressure(MAP),the differences between the two groups were significant(P<0.05).There were no significant differences in preoperative HR and preoperative MAP between the two groups(P>0.05).Conclusion Compared with TAPP,TEP surgery has a disadvantage in terms of intraoperative ECG influence.TEP surgery may cause more abnormal changes in ECG,which requires closely monitoring.

关 键 词：疝 腹股沟 腹腔镜 气腹 心电图 

分 类 号：R656.21[医药卫生—外科学]