老年患者经皮肾镜碎石围术期呼吸功能变化的研究

摘要

目的 观察老年患者经皮肾镜碎石对围术期呼吸功能的影响.方法 选择呼吸功能正常、ASAⅠ～Ⅱ级、年龄60岁以上的肾结石患者60例,其中30例行经皮肾镜碎石术的患者为实验组(A组),30例经腹切开取石术的患者为对照组(B组).监测时间点为麻醉前(T0)、麻醉后10 min(T1)、手术 30 min(T2)、手术60 min(T3)、手术120 min(T4)、术毕前最高值(T5)、术毕后60 min(T6),抽取动脉血和中心静脉血做血气分析,监测项目为手术时间、拔管时间、术后在复苏室(PACU)停留时间 、SvO2、SaO2、PvO2、动脉二氧化碳分压(PaCO2) 、动脉氧分压(PaO2)的变化.根据公式计算出Qs/QT、P(A-a)O2、Cd(动态肺顺应性).结果 两组患者手术时间、拔管时间和PICU停留时间比较差异无统计学意义(P＞0.05),Qs/QT、P(A-a)O2随着时间的延长呈上升趋势,与麻醉前比较差异有统计学意义(P＜0.05),实验组略快于对照组,但两组间差异无统计学意义(P＞0.05) ;Cd两组均呈下降趋势(P＜0.05),与麻醉后比较差异有统计学意义(P＜0.05).实验组和对照组相比无统计学意义(P＞0.05).结论 老年患者呼吸系统老化,肺功能减退,麻醉手术和长时间的俯卧位会导致肺功能减退程度进一步加重,应尽量缩短手术时间.%Objective To investigate the effect of percutaneous nephrolithotripsy on the respiratory function during perioperative period in the elderly. Methods 60 renal calculus patients with normal respiratory function, ASA Ⅰ to Ⅱ, age ＞ 60 years were recruited. Of them,30 patients were given percutaneous nephrolithotripsy( group A ), the others were given transabdominal lithotomy( group B ). The time of monitors were pre-anesthesia( To ), 10 minutes after anesthesia( T1 ),30 minutes after operation( T2 ), 60 minutes after operation( T3 ), 120 minutes after operation( T4 ),peak value pre-operation( T5 ), 60 minutes post-operation( T6 ). The sample of arterial blood and central vein were collected for blood gas analysis. The operation time, time of tube drawing, time of stay in post-anesthetic ICU( PACU ),SvO2,SaO2,PvO2,PaCO2,PaO2 were recorded. Cd,Qs/QT and P( A-a )02 were calculated by the formula. Results The operation time, time of tube drawing, time of staying in PACU were not significantiy different between the two groups ( P ＞ 0.05 ). The Qs/QT and P( A-a )02 elevated with time and significantiy higher than that of pre-anesthesia( P ＜ 0.05 ),but no significant difference were fotmd between the two groups( P ＞ 0.05 ). Cd was significantiy decreased after anesthesia ( P ＜0.05 ), but no significant difference was found between the two groups( P ＞ 0. 05 ). Conclusion The respiratory system in the elderly is aging and the pulmonary function degenerate. The anesthesia and long time of prone position will deteriorate pulmonary function and the time of operation should be shortened.