不同ＣＯ２气腹压力对各年龄段患者手术期间呼吸系统参数影响.docVIP

不同ＣＯ２气腹压力对各年龄段患者手术期间呼吸系统参数影响 　【摘要】 目的：探讨腹腔镜胆囊切除术（ＬＣ）在不同ＣＯ２气腹压力下对不同年龄段患者围手术期呼吸系统各参数的影响。方法：择期行腹腔镜胆囊切除术９０例。按年龄分为３组，２０～４０岁为中青年组，４０～６０岁为中老年组，gt;６０岁为老年组，每组３０例，各组按压力不同分Ａ组（气腹压力８～１２mm Hg）、Ｂ组（气腹压力１４～１６mm Hg）两组，每组１５例，各组间性别，体重无统计学差别。观察各年龄段在不同气腹压力下各时点（气腹前１０min、气腹后１０、２０、３０min、放气后５min）呼吸系统参数（PETＣＯ２、Paw、MVE、VＣＯ２、VＯ２）的变化情况。结果：中青年组和中老年组：在Ａ组、Ｂ组气腹注入后，呼吸系统各参数均有显著变化（Ｐlt;0.01），Ａ、Ｂ两组间比较差异无显著性（Ｐgt;0.05）。老年组：在Ａ组、Ｂ组气腹注入后，呼吸系统各参数均有显著变化（Ｐlt;0.01）。Ａ、Ｂ两组间比较差异显著（Ｐlt;0.01）。结论：（１）ＣＯ２气腹时间延长，会直接影响呼吸系统各参数的变化；（２）ＣＯ２气腹压力增加，会直接影响呼吸系统各参数的变化；（３）随时间延长气腹压力的变化对于中青年组、中老年组呼吸系统参数的影响差异无显著性，如果是健康机体，肺功能正常，手术可根据需要选用任一组气腹压力；（４）老年组气腹压力的变化随时间延长对呼吸系统各参数的影响差异显著。建议最好使用低气腹压力，以８~１２mm Hg为宜。　　【关键词】 胆囊切除术，腹腔镜；ＣＯ２气腹；麻醉，全身；呼吸功能试验 　　Ｔhe effects of LC on respireation system parameters of patients with different ages under defferent ＣＯ２ insufflation pressure during perioperative period 　　【Abstract】Ｏbjective:To investigate the effects of LC on rspireation system parameters of patients with different ages under different ＣＯ２ insufflation pressure duing perioperative period.Ｍethods:Ninety patients were divided into 3 groups of 30.Each group was randomly divided into 2 subgroups of 15 according to different pressures:group A (insufflation pressure 8１２mm Hg),group B(insufflation pressure 1416mm Hg)to observe the chang of respication system parameters (PETＣＯ２,Paw,MVE,VＣＯ２,VＯ２) of patients with differen ages at the point of differen insufflation pressure (before insufflation 10min ,after insufflation 10,20,30min,after withdrawal of ＣＯ2 insufflation 5min).Ｒesults:Adult patients(2040y) and elder patients(4060y):after the input of insufflationsgroup A,group B,the respiration system parameters all changed dramatically（Ｐlt;0.01） while there was no significant difference between group A and group B（Ｐgt;0.05）.Aged patients(gt;60y):after the input of insufflationsgroup A,group B,the respiration system parametes all changed dramatically（Ｐlt;0.01）and there was significant difference between group A and group B（Ｐlt;0.01）.Ｃonclusions:(1)CO2 insufflat