CO_(2)气腹对老年腹腔镜手术患者血气及心肌损伤标志物水平的影响  

Effect of CO_(2) pneumoperitoneum on blood gas parameters and levels of myocardial injury markers in elderly patients undergoing laparoscopic surgery

作　　者：王倩[1] 杜津[2] 杜煜迪 谢克亮[4] Wang Qian;Du Jin;Du Yudi;Xie Keliang(Department of Clinical Laboratory,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Anesthasia,Tianjin Medical University General Hospital,Tianjin 300052,China;Traditional Chinese Medicine Institute of Chengde Medical College,Chengde 067000,HeiBei,China;Department of Critical Care Medicine,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院检验中心,天津300052 [2]天津医科大学总医院麻醉科,天津300052 [3]承德医学院中医学院,河北承德067000 [4]天津医科大学总医院重症医学科,天津300052

出　　处：《中国中西医结合急救杂志》2022年第5期586-589,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：天津市科技项目重点研发计划(18YFZCSY00560)。

摘　　要：目的探讨CO_(2)气腹对老年患者血气及心肌功能的影响,评价腹腔镜手术在老年患者中应用的安全性。方法选取在天津医科大学总医院行腹部外科手术的106例年龄≥60岁的老年患者作为研究对象,55例择期行腹腔镜手术者为观察组,51例择期行非腹腔镜手术者为对照组。于手术前和手术开始后3 h采血,分别检测动脉血气和静脉血肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、高敏肌钙蛋白T(hs-TnT)和N末端脑钠肽前体(NT-proBNP)水平。结果①血气参数:与手术前比较,观察组pH显著降低(7.32±0.07比7.40±0.07,P<0.05),动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))和碳酸氢根(HCO3-)均显著升高〔PaO_(2)(mmHg,1 mmHg≈0.133 kPa):230.13±24.54比93.24±9.21、PaCO(2 mmHg):48.85±8.50比40.70±8.16、HCO3(-mmol/L):33.00±5.85比26.00±5.26,均P<0.05〕,对照组仅PaO_(2)显著升高(mmHg:227.44±26.60比92.13±7.90,P<0.05);手术开始3 h观察组比对照组pH显著降低、PaCO_(2)显著升高〔pH:7.32±0.07比7.39±0.06,PaCO(2 mmHg):48.85±8.50比42.55±6.53,均P<0.05〕,HCO3-升高(mmol/L:33.00±5.85比30.27±5.17,P<0.05)。②心肌损伤标志物:与手术前时比较,手术开始3 h观察组CK、CK-MB和hs-TnT均显著升高〔CK(U/L):76.36±24.30比59.62±19.46,CK-MB(U/L):33.24±10.94比23.60±9.46,hs-TnT(μg/L):0.047±0.036比0.030±0.025,均P<0.05〕,对照组仅CK显著升高(U/L:104.69±34.49比62.67±19.72,P<0.05);手术开始3 h时观察组比对照组CK-MB和hs-TnT显著升高〔CK-MB(U/L):33.24±10.94比24.25±7.78,hs-TnT(μg/L):0.047±0.036比0.039±0.032,P<0.05〕,CK显著降低(U/L:76.36±24.30比104.69±34.49,P<0.05),但心肌损伤标志物水平的增加尚在正常参考值范围内。结论腹腔镜手术中CO_(2)人工气腹对老年患者的呼吸和心脏功能造成一定的影响。连续监测患者血气指标和心肌酶水平,有助于早期发现和判断患者的酸碱失衡及心肌受损程度。Objective To explore the effect of CO_(2)pneumoperitoneum on blood gas parameters and myocardial function,and evaluate the safety of laparoscopic surgery in elderly patients.Methods A total of 106 elderly patients aged≥60 years who received abdominal surgery in Tianjin Medical University General Hospital were enrolled.Fiftyfive patients undergoing laparoscopic surgery were categorized as the observation group,and 51 patients undergoing non-laparoscopic surgery were divided into the control group.Blood samples were taken before and 3 hours after the surgery,the arterial blood gas and the levels of creatine kinase(CK),creatine kinase isoenzyme MB(CK-MB),high-sensitivity troponin T(hs-TnT)and N-terminal brain natriuretic peptide precursor(NT-proBNP)were tested.Results①Blood gas parameters:in the observation group,compared with those before the surgery,pH values was significantly lower(7.32±0.07 vs.7.40±0.07,P<0.05),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))and HCO3-were significantly higher[PaO_(2)(mmHg,1 mmHg≈0.133 kPa):230.13±24.54 vs.93.24±9.21,PaCO_(2)(mmHg):48.85±8.50 vs.40.70±8.16,HCO3-(mmol/L):33.00±5.85 vs.26.00±5.26,all P<0.05]at 3 hours after the surgery.However,only PaO_(2)was significantly higher(mmHg:227.44±26.60 vs.92.13±7.90,P<0.05)in the control group.At 3 hours after the surgery,in the observation group,pH value was lower and PaCO_(2)were significantly higher than those in the control group[pH:7.32±0.07 vs.7.39±0.06,PaCO_(2)(mmHg):48.85±8.50 vs.42.55±6.53,both P<0.05],and HCO3-was higher(mmol/L:33.00±5.85 vs.30.27±5.17,P<0.05)in the observation group than that in the control group.②Myocardial injury markers:CK,CM-MB and hs-TnT were significantly increased in the observation group 3 hours after the surgery compared with those before the surgery[CK(U/L):76.36±24.30 vs.59.62±19.46,CK-MB(U/L):33.24±10.94 vs.23.60±9.46,hs-TnT(μg/L):0.047±0.036 vs.0.030±0.025,all P<0.05],while the level of CK was significantly higher(U/

关 键 词：腹腔镜手术 CO_(2)气腹 血气分析 心肌酶谱 

分 类 号：R656[医药卫生—外科学]