A Comparative Study Of The Effects Of TAPP And TEP On Cardiopulmonary Function In Elderly Patients

Objective:In this study,by comparing the effects of transabdominal preperitoneal（TAPP）and totally extra-peritoneal（TEP）on cardiopulmonary function in elderly patients,the differences between the two surgical methods on cardiopulmonary function in elderly patients were concluded,so as to select a safer surgical method for elderly patients with inguinal hernia.Methods:Fifty-two patients with unilateral inguinal hernia admitted to Changsha Hospital Affiliated to Hunan Normal University from June2019 to January 2021 and meeting the criteria were randomly divided into TAPP group and TEP group.Comparing two kinds of surgical procedure in patients with preoperative,intraoperative and pull out the endotracheal tube after 2 minutes of oxygenation index,partial pressure of carbon dioxide in arterial blood,bicarbonate ions concentration,arterial blood p H value and partial pressure of end-expiratory carbon dioxide,the airway peak pressure,heart rate,and the mean arterial pressure,to determine a surgical procedure that has less effect on cardiopulmonary function in elderly patients with inguinal hernia.Results:1.The general data of two groups of patients in gender,age,height,weight,inguinal hernia（left/right）,the types of inguinal hernia（oblique/direct hernia）,hernia contents are falling in the scrotum,cardiac ejection fraction,pulmonary ventilation function,ASA grade,oxygen index（oxygen partial pressure/oxygen concentration）,arterial partial pressure of carbon dioxide,bicarbonate ions concentration,and arterial blood p H before anesthesia in the operating room.There were no significant differences in heart rate and invasive mean arterial pressure（P>0.05）.2.The differences in oxygenation index,arterial partial pressure of carbon dioxide,bicarbonate ions concentration,arterial blood p H value,partial pressure of end-expiratory carbon dioxide,the airway peak pressure,heart rate and mean arterial pressure were compared between patients in the TAPP group and the TEP group at multiple time points（before entering the operating room without anesthesia,before carbon dioxide pneumoperitoneum after anesthesia,15 minutes and 30 minutes after pneumoperitoneum establishment,after abdominal incision suture,and 2 minutes after tracheal catheter extraction）.The results showed that the heart rate and mean arterial pressure of the TAPP group and the TEP group decreased slowly.After the operation,all of them returned to the preoperative level,and there was no significant difference between the two groups（P>0.05）.Partial pressure of carbon dioxide in arterial blood,partial pressure of end-expiratory carbon dioxide,bicarbonate ions concentration and the airway peak pressure all increased and arterial blood p H value decreased.Partial pressure of carbon dioxide in arterial blood and partial pressure of end-expiratory carbon dioxide increased more in the TEP group（P<0.05）,The airway peak pressure increased more in the TAPP group（P<0.05）,and arterial blood p H value decreased more in the TEP group（P<0.05）.After abdominal incision suturing,partial pressure of end-expiratory carbon dioxide was higher in the TEP group（P<0.05）.Oxygenation index was lower in the TEP group only 2minutes after endotracheal catheter removal at the end of surgery（P<0.05）,and there was no significant difference between the two groups at other times.3.Partial pressure of carbon dioxide in arterial blood at 2 minutes after endotracheal catheter removal was higher than that before surgery（P<0.05）,and arterial blood p H value was lower than that before surgery（P<0.05）in both groups.After abdominal incision suturing,partial pressure of end-expiratory carbon dioxide of TEP group was higher than that before surgery（P<0.05）.Conclusion:1.Both surgical methods will have a certain impact on the cardiopulmonary function of elderly patients.TEP makes elderly patients absorb more CO₂gas during surgery and cause more serious respiratory acidosis.2.After surgery,there was basically no difference between the two surgical methods except that TAPP maintained better oxygenation index after surgery.