老年患者腹腔镜直肠癌根治术气腹状态对呼吸和循环功能的影响

目的观察老年患者行腹腔镜结直肠癌根治术中气腹对其呼吸和循环功能的影响.方法择期行腹腔镜结直肠癌患者40例,ASAⅠ～Ⅱ,分为对照组（年龄〈65岁）及老年组（年龄〉65岁）,每组20例.分别于CO2气腹前,气腹后30、60、120 min及术毕解除气腹后30、60 min监测记录患者CO、MAP、HR、CVP、SpO2、肺胸顺应性（Comp）、呼气末CO2分压（PETCO2）、气道峰压（Ppeak）、气道阻力（Raw）、抽动脉血测PH、PaCO2值,气管导管拔管时间、在PACU停留时间.结果拔管时间和PICU停留时间年老年组明显长于对照组（P〈0.05）;两组患者各时点MAP、HR变化不明显;CO、Comp、pH气腹后明显下降（P〈0.05）,CVP、PETCO2、Ppeak、Raw、PaCO2气腹后明显升高（P〈0.05）,其中各指标优以老年组变化较为明显,与对照组相比差异有统计学意义（P〈0.05）.结论老年患者腹腔镜下行结肠癌根治术会对呼吸和循环功能产生严重的影响,术中术后应加强呼吸和循环功能的管理.

Influence of Pneumoperitoneum on Respiration and Circulation in Radical Resection of Colorectal Cancer through Laparoscope for Aged Patients

Objective To observe the influence of pneumoperitoneum respiration and circulation during laparoscopic radical resection of colorectal cancer for aged patients.Methods 40 ASAⅠ～Ⅱpatients with colorectal cancer scheduled for laparoscopic radical resection were divided in to 2 groups ：Control group（age65） and aged group（age65）,The indicators including MAP,HR,CVP,SpO2,Comp,PETCO2,Ppeak and Raw were monitored and recorded before CO2 pneumoperitoneum,30 minutes,60 minutes,120 minutes and pneumoperitoneum relieved,as well as at time of tracheal catheter extubation and time of stay PACU.Results The time for extubation and stay PACU in aged group were obviously longer than that in control group（P0.05）,the changes IN MAP and HR had no significant difference between the two groups at each time point.CO,Comp and PH were significantly decreased at post-pneumoperitoneum（P0.05）,CVP,PETCO2,Ppeak,Raw,PaCO2 were significantly increased at post-pneumoperitoneum（P 0.05）,the whole indexes in aged group were significantly different from those in control group at each time point（P 0.05）.Conclusion Laparoscopic radical resection of colorectal cancer conducted for aged patients may have severe influences on respiration and circulation function,thus reinforced management to respiration and circulation during operation is advised.