| Objective:In this study,two different methods of inguinal hernia surgery(TAPP and TEP)were compared,respectively,when carbon dioxide gas was injected into different operating spaces,its possible effects on the circulatory system and respiratory system of the elderly patients.By summing up the internal differences,we can further judge and choose the operation mode which has less influence on the elderly patients.Method:From October 2018 to July 2019,based on the single blind and prospective study,we collected the existing case data of patients in our department who met the inclusion criteria,and divided them into two groups according to the operation mode:33 cases were treated with transperitoneal anterior inguinal hernia repair(TAPP group),31 cases were treated with total extraperitoneal inguinal hernia repair(TEP group).The indexes of circulatory system and respiratory system(including heart rate,blood pressure,electrocardiogram,blood gas and atelectasis)before,during and after operation were compared,and statistical analysis was carried out.Finally,a kind of operation mode with little influence on the elderly patients was determined.Result:1.There was no statistical difference in basic demographic indicators(such as age,gender,BMI,etc.)between TAPP group and TEP group(P>0.05),and there was no statistical difference in disease type(inguinal hernia type)and ASA anesthesia risk rating between TAPP group and TEP group(P>0.05).2.There was no significant difference between TAPP group and TEP group(P>0.05).3.The changes of SBP,DBP and HR of patients in TAPP group and TEP group were compared at different time points(before operation,inflation start,inflation end,6 hours after operation and 1 day after operation).The results showed that patients in TAPP group and TEP group had the phenomenon of heart rate slowing down,systolic and diastolic pressure decreasing after inflation.With the end of inflation,the heart rate of patients increased Systolic and diastolic blood pressure increased and gradually returned to preoperative level.The results showed that the difference was statistically significant(P<0.05);the difference was not statistically significant(P>0.05).By comparing the differences of each index between TAPP group and TEP group,the results showed that there was no statistical significance in each time period(P>0.05).4.By comparing the changes of acid-base balance indexes(pH of body fluid,partial pressure of carbon dioxide,PaC02,HC03-of bicarbonate)of patients in TAPP group and TEP group before operation,at the beginning of inflation,at the end of inflation,6 hours after operation and 1 day after operation,the results showed that PetC02 value of partial pressure of carbon dioxide at the end of expiratory period increased and pH of body fluid increased after stopping inflation of carbon dioxide in both groups The results showed that the values of PaC02 and HCO3-decreased and HCO3-increased.There was no significant difference between the two groups(P>0.05).There was no significant difference between the two groups(P>0.05).At the same time,there was significant difference between the two groups(P<0.05).After that,there was no significant difference between the two groups(P>0.05).At last,by comparing the differences of each index between TAPP group and TEP group,the results showed that there was no statistical significance in each time period(P>0.05).Conclusion:There was no significant difference in the effects of TAPP and TEP on the circulation and respiratory system of the elderly patients during the peri operation.The influence of pneumoperitoneum on patients is not considered in the choice of laparoscopic inguinal hernia repair.However,both of these operations will affect the circulatory and respiratory system indexes of the elderly patients due to the carbon dioxide gas filled in the operation,which requires the attention of anesthesiologists and surgeons.Through reasonable adjustment,these indexes can be controlled in a safe range to ensure the smooth operation. |
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