低压气腹对冠状动脉支架置入术后行腹腔镜手术老年患者的影响观察

摘要

Objective To explore the effect of low pressure pneumoperitoneum of laparoscopic cholecystectomy (LC) on elderly patients who had underwent coronary stent implantation.Methods A total of 51 patients with age of 60 years or older who had LC after coronary stent implantation from August 2012 to August 2015 in Beijing Anzhen Hospital,Capital Medical University were divided into 2 groups according to standard pneumoperitoneum(12 mmHg,23 cases) or low pressure pneumoperitoneum (8 mmHg,28 cases)during operation.Operation duration,end-tidal CO2 partial pressure(PETCO2),peak airway pressure(PAP),mean arterial pressure (MAP),heart rate (HR),arterial blood pH value,blood loss,maximum platelet aggregation rate (MPA) and postoperative complications were analyzed.Results Operation duration and postoperative MAP in patients with low pressure pneumoperitoneum were significangtly higher than those in patients with standard pneumoperitoneum [(50 ± 5) min vs (46 ± 7) min,(34 ± 5) ％ vs (30 ± 7) ％] (P ＜ 0.05).PET CO2,PAP after 25 min of pneumoperitoneum and the incidence of shoulder pain in patients with low pressure pneumoperitoneum were significangtly lower than those in patients with standard pneumoperitoneum [(39.3 ± 3.0) mmHg vs (41.8 ± 3.2) mmHg,(18.7 ± 2.4)cmH2O vs (21.7±2.7)cmH2O,14.3％ (4/28) vs43.5％(10/23)](P＜0.05).Conclusion Low pressure pneumoperitoneum of LC for elderly patients with coronary stent implantation can effectively reduce cardiopulmonary function damage,occurrence of complications and risk of laparoscopic surgery.%目的 探讨低压气腹对冠状动脉支架置入术后行腹腔镜胆囊切除术老年患者的影响.方法 选择2012年8月至2015年8月于首都医科大学附属北京安贞医院普外科就诊的51例冠状动脉支架置入术后行腹腔镜胆囊切除术的老年患者(年龄≥60岁),分为标准组[23例,二氧化碳气腹压力12 mmHg(1 mmHg =0.133 kPa)]和低压组(28例,二氧化碳气腹压力8 mmHg).记录并比较2组患者手术时间,气腹前后潮气末二氧化碳分压、气道峰压、平均动脉压、心率及动脉血pH值,出血量,最大血小板凝集率及术后并发症的差异.结果 低压组手术时间及术后最大血小板凝集率高于标准组[(50 ±5) min比(46±7) min,(34±5)％比(30±7)％],气腹后25 min的潮气末二氧化碳分压、气道峰压及术后肩痛发生率低于标准组[(39.3 ±3.0) mmHg比(41.8±3.2) mmHg,(18.7 ±2.4) cmH2O(1 cmH2O =0.098 kPa)比(21.7 ±2.7) cmH2O,14.3％(4/28)比43.5％ (10/23)],差异均有统计学意义(P＜0.05或P＜0.01).结论 对于冠状动脉支架置入术后行腹腔镜胆囊切除术的老年患者,低压气腹可以有效降低心肺功能损伤,减少并发症的发生,减低腹腔镜手术风险.