CAJ | 학술논문

目的评价老年患者在腹腔镜结直肠手术中的安全性.方法 2007年8月至12月,对25例行腹腔镜结直肠手术的乙状结肠和直肠肿瘤患者按年龄分成老年组(大于或等于70岁,10例)和对照组(小于70岁,15例),在手术的不同时间段监测其循环功能、酸碱平衡、脏器灌注等指标并进行对比分析.结果老年组患者除ASA分级明显高于对照组(P<0.01)外,两组在性别、身高、体质量、疾病分类、手术方式、手术时间、术中出血和术后并发症方面差异无统计学意义(均P>0.05).动脉血气分析指标显示,手术中碳酸氢根(HCO3)值和二氧化碳分压(PaCO2)值较术前明显上升(P<0.05),pH值较术前明显下降(P<0.05),随着手术时间延长上述各项指标的变化进一步明显;术后各项指标有不同程度恢复.电解质指标术中钾和钙较术前下降明显(P<0.05);循环指标的中心静脉压(CVP)在扩容后及手术开始后明显升高,术后迅速下降(P<0.05);平均动脉压(MAP)在扩容时和麻醉后初期变化比较显著(P<0.05),心率(HH)、心指数(CI)和每搏输出指数(SI)总体比较平稳;脏器灌注指标中胃黏膜pH值(phi)术后逐渐下降一直延续到术后(P<0.05);胃黏膜CO2分压(PgCO2)术后明显上升.除了老年组CVP在术中5 min时明显高于对照组、MAP值在术后15 min时明显低于对照组外,两组间各项指标比较,差异均无统计学意义(P>0.05),但指标的绝对值老年组变化幅度更大,术后恢复则相对较慢.结论 70岁以上患者腹腔镜结直肠手术时,CO2气腹及头低体位会产生代谢性酸中毒、心脏负担加重及脏器灌注减少等现象,代偿能力较差,但通过合理的麻醉管理,可以将不利影响控制在安全范围内.
목적 평개노년환자재복강경결직장수술중적안전성.방법 2007년8월지12월,대25례행복강경결직장수술적을상결장화직장종류환자안년령분성노년조(대우혹등우70세,10례)화대조조(소우70세,15례),재수술적불동시간단감측기순배공능、산감평형、장기관주등지표병진행대비분석.결과 노년조환자제ASA분급명현고우대조조(P<0.01)외,량조재성별、신고、체질량、질병분류、수술방식、수술시간、술중출혈화술후병발증방면차이무통계학의의(균P>0.05).동맥혈기분석지표현시,수술중탄산경근(HCO3)치화이양화탄분압(PaCO2)치교술전명현상승(P<0.05),pH치교술전명현하강(P<0.05),수착수술시간연장상술각항지표적변화진일보명현;술후각항지표유불동정도회복.전해질지표술중갑화개교술전하강명현(P<0.05);순배지표적중심정맥압(CVP)재확용후급수술개시후명현승고,술후신속하강(P<0.05);평균동맥압(MAP)재확용시화마취후초기변화비교현저(P<0.05),심솔(HH)、심지수(CI)화매박수출지수(SI)총체비교평은;장기관주지표중위점막pH치(phi)술후축점하강일직연속도술후(P<0.05);위점막CO2분압(PgCO2)술후명현상승.제료노년조CVP재술중5 min시명현고우대조조、MAP치재술후15 min시명현저우대조조외,량조간각항지표비교,차이균무통계학의의(P>0.05),단지표적절대치노년조변화폭도경대,술후회복칙상대교만.결론 70세이상환자복강경결직장수술시,CO2기복급두저체위회산생대사성산중독、심장부담가중급장기관주감소등현상,대상능력교차,단통과합리적마취관리,가이장불리영향공제재안전범위내.
Objective To compare the outcomes of laparoscopic colorectal surgery in elderly (≥ 70 years) and younger (< 70 years) patients, and to evaluate the safety of laparoscopic colorectal surgery in elderly. Methods From Aug. 2007 to Dec. 2007, 25 patients with colorectal cancer undergone laparoscopic colorectal surgery were studied prospectively. Ten patients aged 70 years or older (Elder Group), and 15 patients less than 70 years (Younger Group). The parameters of perioperative hemodynamics, blood chemistry, and intraabdominal organs perfusion were recorded periodically during operation and compared between the two groups. Results Elder group had a higher ASA degree (P<0.01). Mean age, height, weight, the classification of the disease, operative time, blood loss and complication were not significantly different between the two groups. The HCO3 value and PaCO2 value increased significantly intraoperatively, while the pH value decreased significantly. These parameters returned to basal line at the end of operation, with the decreased electrolytes, especially the kaliopenia and hypocalcemia. The CVP increased significantly at the beginning of operation and after fluid expansion, and decreased postoperatively. Gastric mucosal pH(pHi) decreased when the operation began. The partial pressure of gastric mucesa (PgCO2) increased significantly at the end of operation.Other parameters of hemodynamics including HR, CI, and SI were not significantly different during operation. The CVP of elder group was higher than that of younger group at 5 min after the beginning of the operation, while the MAP of elder group was lower than that of younger at 15 min after the end of the operation. Other parameters of hemodynamics including oxygenation, pedusion, and blood chemistry were not significantly different. Conclusions For laparoscopic colorectal surgery, no significant adverse response attributes to elderly patients. The compensation capacity of the elderly is lower. With the reasonable anesthesia administration, the adverse response can be controlled effectively.