老年患者腹腔镜结直肠手术的安全性研究

Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.     

胃张力计监测的临床应用与研究进展

胃张力计是用于监测胃肠遵粘膜二氧化碳分压的技术，可以敏感地反映内脏血流灌注及氧合状态。本文根据近年文献对这项技术进行回顾，概括了几十年来胃张力计的发展过程，理论根据及临床应用进展。     

老年患者腹腔镜结直肠手术的安全性研究

Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.     

腹腔镜结直肠手术中以不同溶液行高容量填充对胃黏膜灌注的影响

目的 应用胃黏膜张力计评估以不同溶液行高容量填充对腹腔镜结直肠手术中胃黏膜灌注的影响.方法 择期行腹腔镜下结直肠手术患者36例,随机均分为乳酸林格液(RL)组、琥珀酰明胶注射液(Gel)组和高渗氯化钠羟乙基淀粉40注射液(HS)组,在全身麻醉诱导期行高容量填充.比较基础时(T1)、扩容结束时(T2)、气腹后5 min(T3)、气腹后15 min(T4)、气腹后30 min(T5)、气腹后60 min(T6)及结束气腹后5 min(T7)、15 min(Ts)、25 min(T8)时各组间的动脉血血气分析、无创血流动力学、胃黏膜张力计测定值和中心静脉压(CVP).此外,3组患者均按年龄分为两个亚组,A亚组年龄＜65岁,B亚组年龄≥65岁.结果 3组间的基本情况、手术情况、麻醉诱导前的各项数据的差异均无统计学意义(P值均＞0.05).T2时间点后,3组的红细胞压积(Hct)均下降,以Gel组的下降程度较为明显且维持时间较长.3组胃黏膜-血二氧化碳分压差(Pg-aCO2)在T:时间点后开始下降,T5时间点后回升,但始终未超过基础值.3组间Pg-aCO2、胃黏膜二氧化碳(PgCO2)、胃黏膜pH值(pHi)和黏膜一呼气末二氧化碳分压(Pg-etCO2)的差异均无统计学意义(P值均＞0.05).HS组T2～T9时间点血Na+均显著高于T1时间点及RL、Gel组(P值均＜0.01).RL组和Gel组的血浆碳酸氢根(HCO3)自T2时间点开始持续上升,直至T7时间点后下降,此现象在HS组不明显.RL组和Gel组中,B亚组血压波动较A亚组明显.结论 腹腔镜下行结直肠癌手术对患者的循环状况有一定程度的影响.麻醉诱导期行高容量填充可改善胃黏膜灌注的情况,不同溶液均可在早期达到良好的效果.HS在这类手术中可维持更为平稳的血流动力学效果,但在输注后即刻有一过性的轻度高钠血症,对术前已有高钠血症者应慎用.     

老年脑出血开颅术后不同类型病原菌颅内感染对脑脊液NSE、NLRP3、HBP水平的影响

目的探讨老年脑出血开颅术后不同类型病原菌颅内感染对脑脊液神经特异性烯醇化酶(NSE)、核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)、肝素结合蛋白(HBP)水平的影响。方法选取2019年8月至2021年10月上海交通大学医学院附属瑞金医院116例老年脑出血开颅术患者,根据术后并发颅内感染与否分为感染组35例,非感染组81例。比较两组患者基本情况、术后脑脊液NSE、NLRP3、HBP水平,Logistic回归分析老年脑出血开颅术后颅内感染影响因素,术后行腰椎穿刺采集脑脊液,进行病原菌培养,对比感染组不同病原菌类型患者术后脑脊液NSE、NLRP3、HBP水平,并绘制ROC曲线,评价脑脊液NSE、NLRP3、HBP水平对颅内感染的诊断价值。结果感染组患者术后脑脊液NSE、NLRP3、HBP水平均高于非感染组患者,差异有统计学意义(P<0.05);Logistic回归分析可知,NSE、NLRP3、HBP水平均与老年脑出血开颅术后颅内感染独立相关(P<0.05);35例老年脑出血开颅术后颅内感染患者共分离出42例病原菌,其中革兰氏阴性菌占45.24%,革兰氏阳性菌54.76%;老年...     

诱导期急性超容量液体填充对腹腔镜结肠直肠手术老年病人内脏灌注的影响

目的：观察全麻诱导期应用晶体液或胶体液行急性超容量液体填充（acute hypervolemic fluid infusion,AHFI）对腹腔镜结肠直肠手术老年病人内脏灌注的影响。方法：腹腔镜结肠直肠手术老年病人30例,ASAⅠ～Ⅱ级,男17例,女13例,年龄65～85岁,随机分为乳酸钠林格液组（R组）、琥珀酰明胶组（G组）和高渗氯化钠羟乙基淀粉40注射液组（H组）,每组各10例,全麻诱导开始后30 min内分别输注乳酸钠林格液、琥珀酰明胶12 mL/kg,或高渗氯化钠羟乙基淀粉40注射液3.5 mL/kg。在诱导前即刻（T0）,AHFI结束时（T1）,气腹后5 min（T2）、15 min（T3）、30 min（T4）、60 min（T5）,结束气腹后5 min（T6）、15min（T7）、25min（T8）时监测并记录血流动力学指标、动脉血气分析结果和胃黏膜张力计测定值。结果：3组胃黏膜-血二氧化碳分压（Pg-aCO2）在T1时低于基础值;在T2降至最低点,且G组明显低于R组;随后,3组Pg-aCO2较T2逐渐升高,且R组T4~7和H组T6时Pg-aCO2高于基础值。3组胃黏膜pH随着气腹时间的延长而逐渐降低,R和H组pHi在T5~8低于7.32,但G组pHi在各时点均高于7.32。R组心指数和心室收缩加速指数在T2明显低于基础值,T6时中心静脉压明显低于G和H组。H组T1～7Na＋高于R和G组。结论：诱导期AHFI能改善腹腔镜结肠直肠手术老年病人内脏器官的血流灌注。与R和H比较,G在较长时间气腹（60 min）仍能维持良好的内脏灌注。     

老年患者腹腔镜结直肠手术的安全性研究

Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.     

老年患者腹腔镜结直肠手术的安全性研究

Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.     

老年患者腹腔镜结直肠手术的安全性研究

Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.     

老年患者腹腔镜结直肠手术的安全性研究

Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.