气腹及病人体位对腹腔镜胆囊切除术血流动力学的影响

doi:10.16139/j.1007-9610.2019.01.015

摘要/Abstract

摘要： 目的: 探讨CO₂气腹及病人体位变化对腹腔镜胆囊切除血流动力学的影响。方法: 57例择期行腹腔镜胆囊切除术病人,男24例,女33例,平均年龄（59.42+12.97）岁, ASA分级Ⅰ~Ⅱ。采用连续无创动脉血压监测系统监测病人血流动力学。记录病人入室时（T0）、气管插管后5 min（T1）、创建人工气腹时（T2）、左侧头高20°体位（rT位）（T3）、气腹建立15 min后（T4）时的心率、动脉收缩压（SAP）、动脉舒张压（DAP）、平均动脉压（MAP）、心输出量（CO）、每搏量（SV）、外周血管阻力（SVR）、脉压变异度（PPV）的变化。结果: T1 SAP较T0明显降低,T2和T3恢复到基础值水平,T3较T1和T2明显升高（P<0.05）。T2 DAP较T1明显升高,T3较T0、T1、T2和T4明显升高（P<0.05）。T3 MAP较其余各时点明显升高（P<0.05）。T2~T4 CO较T0和T1均明显降低（P<0.05）。T2 SV较T0明显降低,T3较T0和T1明显降低（P<0.05）。T2和T4 SVR较T0和T1明显升高, T3较T0~T2明显升高（P<0.05）。T2和T4 PPV较T0和T1明显升高,T3较T0、T1及T4均明显升高（P<0.05）。心率在5个时间点变化不明显,差异无统计学意义。结论: 腹腔镜胆囊切除术中,CO₂气腹可降低CO和SV、升高SVR和PPV,但对血压影响小。CO₂气腹合并rT位使SVR进一步升高,从而使血压发生明显变化。

关键词: 腹腔镜胆囊切除术, CO₂气腹, 体位, 血流动力学

Abstract: Objective To investigate the effects of carbon dioxide pneumoperitoneum and patients position on hemodynamic during laparoscopic cholecystectomy. Methods A total of 57 patients (24 male,33 female) aged (59.42+12.97) years with American Society of Anesthesiologists score Ⅰ-Ⅱ undergoing laparoscopic cholecystectomy were enrolled in this study. Continuous non-invasive arterial pressure monitoring system(CNAP) was used. Hemodynamic indexes including heart rate (HR), arterial systolic blood pressure (SAP), arterial diastolic pressure (DAP), mean arterial pressure (MAP), cardiac output (CO), stroke volume (SV), peripheral vascular resistance (SVR) and pulse pressure variation degree (PPV) were recorded by CNAP after entering operating room(T0), at 5 min after endotracheal intubation(T1), after artificial pneumoperitoneum(T2), on the left side of the head high 20 degree position which is re-Trendelenburg position (rT position) (T3) and 15 minutes after establishment of pneumoperitoneum (T4). Results SAP was significantly lower at T1 compared with at T0, restored to basal level at T2 and T3, and was higher at T3 compared with at T1 and T2 (P<0.05). DAP was significantly higher at T2 than at T1, and higher at T3 compared with at T0, T1, T2 and T4 (P<0.05). MAP at T3 was the highest when compared with those at other time points (P<0.05). CO decreased at from T2 to T4 compared at T0 and T1 (P<0.05). SV was significantly lower at T2 compared with at T0, and lower at T3 compared with at both T0 and T1(P<0.05). SVR was significantly higher at T2 and T4 than at both T0 and T1, and higher at T3 than at from T0 to T2 (P<0.05). PPV was higher at T2 and T4 than at both T0 and T1, higher at T3 than at T0, T1 and T4 (P<0.05). HR showed no obvious change in 5 time points. Conclusions Carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy may decrease CO and SV, and elevate SVR and PPV, but has no effect on blood pressure. Carbon dioxide pneumoperitoneum combined with rT position would elevate SVR further so there is obvious changes in blood pressure.

Key words: Laparoscopic cholecystectomy, Carbon dioxide pneumoperitoneum, Position, Hemodynamics

中图分类号:

R657.4

罗颖, 钱洁敏, 陈晓薇, 马海燕, 许萍, 刘琳娜, 倪强. 气腹及病人体位对腹腔镜胆囊切除术血流动力学的影响[J]. 外科理论与实践, 2019, 24(01): 70-74.

LUO Ying, QIAN Jiemin, CHEN Xiaowei, MA Haiyan, XU Ping, LIU Linna, NI Qiang. Effect of pneumoperitoneum and patient position on hemodynamics during laparoscopic cholecystectomy[J]. Journal of Surgery Concepts & Practice, 2019, 24(01): 70-74.

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