老年人经腹腔镜和剖腹胆囊切除术对围手术期肺功能影响的比较

目的 比较经腹腔镜和剖腹胆囊切除术对老年人围术期肺功能的影响。方法 １２０例在全身麻醉下经腹腔镜和剖腹行胆囊切除术的老年患者分别为肺功能正常和异常组，术中监测肺功能多项指标，比较手术对肺功能的影响。结果 （１）腹腔镜肺功能正常组和异常组：ＣＯ２气腹后气末二氧化碳分压（ＰｅｔＣＯ２）、气道人压（Ｐｐｅａｋ）、气道平台压（Ｐｐｌａｔ）、动脉血二氧化碳分压（ＰａＣＯ２）均明显增高，分别上升１４．５％、４

A comparison of the effects of perioperative pulmonary function in laparoscopic and laparotomic cholecystectomy in elderly patients

Objective To compare the effects of perioperative pulmonary function in laparoscopic and laparotomic cholecystectomy in elderly patients. Methods One handred and twenty patients suffering from cholecystitis and under going laparoscopic or laparotomic cholecystectomy were further divided into two groups on the basis of normal or abnormal pulmonary function. A standardized general anesthetic technique was used for all the patients. All pulmonary function parameters were monitored during the operation to compare the effects of pulmonary function in either laparoscopic or laparotomic cholecystectomy. Results (1)In laparoscopic groups with normal and abnormal pulmonary function, the end tidal carbon dioxide pressure (PetCO 2), airway peak pressure (Ppeak), airway plat pressure (Pplat),and arterial carbon dioxide pressure (PaCO 2) were increased (14 5%,45 1%,60 0% and 18 5% respectively) during the peritoneal insufflation, whereas, both respiratory compliance (C) and pH value (pH) were decreased significantly (42 0% and 2 7%) as compared with the preinsufflation value( P <0 01). After deflation of peritoneal cavity, the PetCO 2, Ppeak, Pplat, C, pH, and PaCO 2 recovered to preinsufflation level. (2)In laparotomic groups with normal or abnormal pulmonary function, no striking difference could be found during and after laparotomy in PetCO 2, Ppeak, Pplat, C, pH,and PaCO 2.(3)Between laparoscopic groups and laparotomic groups, striking difference was found during the operation, but not after the operation. (4)Postoperative pulmonary complications were much more and hospitalization was much longer in laparotomic groups than in laparoscopic groups. Conclusions Laparoscopic cholecystectomy is better than laparotomic cholecystectomy in geriatric patients with mild or moderate pulmonary dysfunction.