腹腔镜手术中不同气腹压力对老年患者血流动力学及血气的影响

摘要

观察不同气腹压力对老年患者腹腔镜中血流动力学和动脉血气的影响.方法65岁以上择期行腹腔镜直肠癌根治术的老年患者30例,随机均分为两组,术中分别采用气腹压10 mm Hg(L组)和14 mm Hg(H组).分别于气腹前15 min(T0)、平卧位气腹后15m in(T1)、气腹并体位改变后15 min(T2)、30 mmin(T3)、60 min(T4)、120min(T5)、气腹结束并平卧位后15 min(T6)记录MAP、CVP、肺动脉楔压(PCWP)、肺平均动脉压(MPAP)、CO,计算CI、体循环阻力(SVR)、肺循环阻力(PVR),抽取动脉血测定pH、PaCO2、PaO2.结果 与T0时比较,两组患者在T1～T5时MAP、CVP、PCWP、MPAP、PaCO2显著升高(P＜0.01),pH明显下降(P＜0.05)；T1时CI和PVR明显下降(P＜0.01),SVR明显升高(P＜0.01);T2时CI和PVR明显升高(P＜0.01),SVR明显下降(P＜0.01).T2～T5时,H组MAP、CVP、PCWP、MPAP显著高于、HR显著快于L组(P＜0.05或P＜0.01).结论腹腔镜手术中气腹压14 mm Hg比10 mm Hg对老年患者血流动力学和动脉血气影响更大.%Objective To study the effects of different pneumoperitoneal pressures on hemodynamics and arterial blood gas in geriatric patients during laparoscopic surgery. Methods Thirty geriatric patients (aged > 65 years) scheduled for elective laparoscopic radical resection of rectal cancer were randomly divided into two groups: group L (n=15, the intra-abdominal pressure was kept at 10 mm Hg) and group H (n= 15, the intra-abdominal pressure was kept at 14 mm Hg). After tracheal intubation, MAP, CVP, PCWP, MPAP and CO was recorded and used to derive hemodynamic parameters CI, SVR and PVR Meanwhile, pH, PaCO2 and PaO2 was determined by arterial blood gas analysis. Date were collected at seven time points: 15 minutes before pneumoperitoneum (T0), 15 minutes after pneumoperitoneum was created and maintained at certain pressure, still in supine position (T1), 15 min (T2), 30 min (T3), 60 min (T4) and 120 min (T5) after changing to Trendelenburg's position (20°), 15 minutes after the conclusion of pneumoperitoneum and returning to supine position (T8). Results After pneumoperitoneum was created, MAP, CVP, PCWP, MPAP and PaCOz increased significantly while pH decreased significantly in both groups at T1-T5 than those at T0 (P<0. 01). Compared with T0 , SVR increased significantly, PVR and CI decreased significantly at T1 (P<0. 01) in both groups. After patients were placed in Trendelenburg's position (T2), SVR decreased significantly while PVR and CI increased significantly in both groups compared with those at T1 (P<0. 01). During pneumoperitoneum (T2-T5), MAP, CVP, PCWP, MPAP and HR in group H were higher than those in group L (P<0. 05 or P<0. 01). Conclusion High pneumoperitoneal pressure (14 mm Hg) exerts greater effect on the hemodynamics and arterial blood gas in geriatric patients during laparoscopic surgery than low pneumoperitoneal pressure (10 mm Hg).