摘要
目的探讨CO_(2)气腹对老年患者血气及心肌功能的影响,评价腹腔镜手术在老年患者中应用的安全性。方法选取在天津医科大学总医院行腹部外科手术的106例年龄≥60岁的老年患者作为研究对象,55例择期行腹腔镜手术者为观察组,51例择期行非腹腔镜手术者为对照组。于手术前和手术开始后3 h采血,分别检测动脉血气和静脉血肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、高敏肌钙蛋白T(hs-TnT)和N末端脑钠肽前体(NT-proBNP)水平。结果①血气参数:与手术前比较,观察组pH显著降低(7.32±0.07比7.40±0.07,P<0.05),动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))和碳酸氢根(HCO3-)均显著升高〔PaO_(2)(mmHg,1 mmHg≈0.133 kPa):230.13±24.54比93.24±9.21、PaCO(2 mmHg):48.85±8.50比40.70±8.16、HCO3(-mmol/L):33.00±5.85比26.00±5.26,均P<0.05〕,对照组仅PaO_(2)显著升高(mmHg:227.44±26.60比92.13±7.90,P<0.05);手术开始3 h观察组比对照组pH显著降低、PaCO_(2)显著升高〔pH:7.32±0.07比7.39±0.06,PaCO(2 mmHg):48.85±8.50比42.55±6.53,均P<0.05〕,HCO3-升高(mmol/L:33.00±5.85比30.27±5.17,P<0.05)。②心肌损伤标志物:与手术前时比较,手术开始3 h观察组CK、CK-MB和hs-TnT均显著升高〔CK(U/L):76.36±24.30比59.62±19.46,CK-MB(U/L):33.24±10.94比23.60±9.46,hs-TnT(μg/L):0.047±0.036比0.030±0.025,均P<0.05〕,对照组仅CK显著升高(U/L:104.69±34.49比62.67±19.72,P<0.05);手术开始3 h时观察组比对照组CK-MB和hs-TnT显著升高〔CK-MB(U/L):33.24±10.94比24.25±7.78,hs-TnT(μg/L):0.047±0.036比0.039±0.032,P<0.05〕,CK显著降低(U/L:76.36±24.30比104.69±34.49,P<0.05),但心肌损伤标志物水平的增加尚在正常参考值范围内。结论腹腔镜手术中CO_(2)人工气腹对老年患者的呼吸和心脏功能造成一定的影响。连续监测患者血气指标和心肌酶水平,有助于早期发现和判断患者的酸碱失衡及心肌受损程度。
Objective To explore the effect of CO_(2)pneumoperitoneum on blood gas parameters and myocardial function,and evaluate the safety of laparoscopic surgery in elderly patients.Methods A total of 106 elderly patients aged≥60 years who received abdominal surgery in Tianjin Medical University General Hospital were enrolled.Fiftyfive patients undergoing laparoscopic surgery were categorized as the observation group,and 51 patients undergoing non-laparoscopic surgery were divided into the control group.Blood samples were taken before and 3 hours after the surgery,the arterial blood gas and the levels of creatine kinase(CK),creatine kinase isoenzyme MB(CK-MB),high-sensitivity troponin T(hs-TnT)and N-terminal brain natriuretic peptide precursor(NT-proBNP)were tested.Results①Blood gas parameters:in the observation group,compared with those before the surgery,pH values was significantly lower(7.32±0.07 vs.7.40±0.07,P<0.05),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))and HCO3-were significantly higher[PaO_(2)(mmHg,1 mmHg≈0.133 kPa):230.13±24.54 vs.93.24±9.21,PaCO_(2)(mmHg):48.85±8.50 vs.40.70±8.16,HCO3-(mmol/L):33.00±5.85 vs.26.00±5.26,all P<0.05]at 3 hours after the surgery.However,only PaO_(2)was significantly higher(mmHg:227.44±26.60 vs.92.13±7.90,P<0.05)in the control group.At 3 hours after the surgery,in the observation group,pH value was lower and PaCO_(2)were significantly higher than those in the control group[pH:7.32±0.07 vs.7.39±0.06,PaCO_(2)(mmHg):48.85±8.50 vs.42.55±6.53,both P<0.05],and HCO3-was higher(mmol/L:33.00±5.85 vs.30.27±5.17,P<0.05)in the observation group than that in the control group.②Myocardial injury markers:CK,CM-MB and hs-TnT were significantly increased in the observation group 3 hours after the surgery compared with those before the surgery[CK(U/L):76.36±24.30 vs.59.62±19.46,CK-MB(U/L):33.24±10.94 vs.23.60±9.46,hs-TnT(μg/L):0.047±0.036 vs.0.030±0.025,all P<0.05],while the level of CK was significantly higher(U/L:104.69±34.49 vs.62.67±19.72,P<0.05)in the control group.The levels of CK-MB and hs-TnT were significantly higher[CK-MB(U/L):33.24±10.94 vs.24.25±7.78;hs-TnT(μg/L):0.047±0.036 vs.0.039±0.032,both P<0.05],while CK was significantly lower(U/L:76.36±24.30 vs.104.69±34.49,P<0.05)in the observation group than that in the control group 3 hours after the surgery.However,the increase in the levels of myocardial injury markers were still within the normal range.Conclusions CO_(2)pneumoperitoneum has an influence on blood gas parameters and myocardial function in elderly patients who underwent laparoscopic surgery.Continuous monitoring of those parameters will contribute to the early detection and evaluation of the extent acid-base imbalance and the degree of myocardial damage.
作者
王倩
杜津
杜煜迪
谢克亮
Wang Qian;Du Jin;Du Yudi;Xie Keliang(Department of Clinical Laboratory,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Anesthasia,Tianjin Medical University General Hospital,Tianjin 300052,China;Traditional Chinese Medicine Institute of Chengde Medical College,Chengde 067000,HeiBei,China;Department of Critical Care Medicine,Tianjin Medical University General Hospital,Tianjin 300052,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2022年第5期586-589,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
天津市科技项目重点研发计划(18YFZCSY00560)。
关键词
腹腔镜手术
CO_(2)气腹
血气分析
心肌酶谱
Laparoscopic surgery
Carbon dioxide pneumoperitoneum
Blood gas analysis
Myocardial enzymogram
