摘要
目的比较不同年龄患者腹腔镜胆囊切除术中肾血流量的变化。方法择期行腹腔镜胆囊切除术患者60例，年龄18～75岁，ASA分级Ⅰ或Ⅱ级，性别不限，体重48～78妇，根据年龄分为2组（n=30）：中青年组（18～60岁）和老年组（61～75岁）。经口气管插管后置人食管超声探头，分别于气腹前、气腹1、5、10、15、20、30min、气腹结束后1和5min时，采用经食管超声心动图测量左肾动脉主干内径（RAD）和血流速度时间积分（VTI），计算左肾血流量（LRAF），记录最大下降时间点，计算最大下降百分比。结果与气腹前比较，两组气腹各时点和气腹结束后1min时RAD、VTI和LRAF降低（P〈0．05）。与中青年组比较，老年组气腹前LRAF降低，最大下降时间点延迟（P〈0．05），最大下降百分比差异无统计学意义（P〉0．05）。结论中青年患者和老年患者腹腔镜胆囊手术中肾血流量均发生可逆性下降；老年患者最大下降时间延迟。
Objective To compare the changes in renal blood flow in elderly and adult patients during laparoscopic cholecystectomy. Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-75 yr, weighing 48- 78 kg, undergoing elective laparoscopic cholecystectomy were enrolled in this study. The patients were divided into 2 groups according to the age （n = 30） ： group Ⅰ young and middle-age （18-60 yr） and group Ⅱ elderly （61-75 yr） . Anesthesia was induced with midazolam, fentanyl, propofol and vecuromium and maintained with infusion of propofol and remifentanil, isoflnraae inb.alation and intermittent iv boluses of vecuromium. The patients ,sere intubated and mechanically ventilated. PerCOz was maintained at 30-40 mm Hg. The probe of transesophageal echocardiography （TEE） was inserted into esophagus after tracheal intubation. The internal diameter and time integral of left renal artery were measured by TEE before pneumoperitoneum （baseline） and at 1, 5, 10, 15, 20 and 30 min of pneumoperitoneum and 1, 5 min after deflation. The blood flow of left renal artery （LRAF） was calculated. The maximal derease in LRAF during pneumoperitoneum was analyzed. Results The internal diameter and time integral of left renal artery and LRAF were significantly decreased during peumoperitoneum and at 1 min after defla- tion in both groups （ P 〈 0.05 ）. LRAF before peumoperitoneum was significantly lower, and the time point of LRAF maximum decrease during pneumoperitoneum was later in group Ⅱ than in group Ⅰ （ P 〈 0.05）. Conclusion The renal blood flow is temporary decreased during laparoscopic eholecystectomy both in young and middle age and elderly patients. The time point of LRAF maximum decrease in elderly patients is later than that in adult patients.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2011年第11期1299-1301,共3页
Chinese Journal of Anesthesiology
关键词
胆囊切除术
腹腔镜
肾循环
老年人
Cholecystectomy, laparoscopie
Renal circulation
Aged
