腹腔镜胆囊切除术气腹过程对老年患者呼吸循环的影响.DOCVIP

临床医学论文-腹腔镜胆囊切除术气腹过程对老年患者呼吸循环的影响 【关键词】? 气腹 　　【摘要】 目的? 探讨腹腔镜胆囊切除手术CO 2 气腹对80岁以上老年患者呼吸循环的影响。 方法? 总结80岁以上高危老年患者腹腔镜胆囊切除术麻醉36例，男15例，女21例，均采用气管插管、静脉-吸入复合全身麻醉。 结果? CO 2 气腹期间，血流动力学变化不大，与气腹前比较，P0.05;EtCO 2 、FEV 1 、有效动力性胸肺顺应性（EDC）变化显著（P0.05），但属正常范围。 结论? CO 2 气腹可引起EtCO 2 升高、FEV 1 、EDC轻度下降及轻微的循环抑制，只要严密监测患者各项指标，及时调整处理，老年患者可以很好地耐受腹腔镜胆囊切除手术。???? 　　关键词? 腹腔镜胆囊切除术 气腹 气管插管 全身麻醉????? 　　Influence of the laparoscopy cholecystectomy pneumoperitoneum process on respiration and circulation of elderly sufferers????? 　　??? 　　【Abstract】 Objective To explore influences of laparoscopic cholecystectomy CO 2 pneumoperitoneum on res-piration and circulation of elderly sufferers over80years.Methods 36cases aged over80years were anesthetized by tracheal intubation and composited venous-inhalation anethesia to perform laparoscopic cholecystectomy，male15cas-es，female21cases.Results In the course of pneumoperitoneum，hemodynamics of the patients was mildly changed compared with that before the treatment（P0.05）。EtCO 2 ，FEV 1 ，and efficiency dynamics conformability（EDC）were altered markedly（P0.05），but its in the normal range.Conclusion CO 2 s pneumoperitoneum may elevate EtCO 2 ，lower FEV 1 and EDC mildly，inhibite circulating slightly.Elderly sufferers would be tolerated laparoscopic cholecystectomy smoothly as long as the various indications of the patients monitored carefully and handled timely.??? 　　Key words laparoscopy cholecystectomy pneumoperitoneum trachea intubated general anesthesia?????? 　　自1988年首次报道腹腔镜胆囊切除术（laparoscopy cholecystectomy，LC）取得成功以来，由于与传统开腹术式比较具有创伤小、术后痛苦少、恢复快、并发症少、住院时间短等优点，因而得以迅速推广。LC手术的特殊之处是需要建立CO 2 气腹，对生理的影响却比开腹更为严重，为此对72例老年患者LC麻醉进行总结，以探讨CO 2 气腹对老年患者的影响。???? 　　1 资料与方法???? 　　选取80岁以上胆囊结石行腹腔镜胆囊切除术患者72例，男29例，女43例;年龄80～92岁，术前30min均肌注阿托品0.5mg，患者进入手术室后开通静脉，Derex-Ohmeda CardiocapⅡ监护仪监测HR、BP、SpO 2 ，Detax-Ohmeda Carnomac Ultima监护仪监测EtCO 2 、FEV 1 、流量-容积环（V-V环）、有效动力性胸肺顺应性［又称有效动力性顺应性（efficiency dynamics conformability，EDC）］;面罩吸氧3min，以氟芬合剂（氟哌啶5mg+芬太尼0.2mg）6ml缓慢静注后，以异丙酚1.5mg/kg缓慢静注