摘要
目的探讨腹腔镜手术特殊的体位及CO2气腹对下肢深静脉血流动力学的影响。方法通过彩色多普勒测定30例腹腔镜手术患者气腹前及气腹后3种体位下（平卧位、头高脚低位、头低脚高位）股静脉直径、平均血流速度及血流量。结果与气腹前比较，气腹后股静脉直径显著增大（P〈0．01），平均血流速度及血流量显著减少（P〈0．01）；气腹建立后与平卧位比较，头高脚低位股静脉直径显著增大（P〈0．05），平均血流速度及血流量显著减少（P〈0．05），头低脚高位股静脉直径显著减小（P〈0．01），平均血流速度及血流量显著增大，但仍达不到气腹前水平（P〈0．0I，P〈0．05）。结论CO2气腹及头高脚低位可协同作用使血液回流不畅，增加术后下肢深静脉血栓发生的风险；头低脚高位有利于血液的回流，可改善CO2气腹所致血液回流不畅，降低术后下肢深静脉血栓发生的风险。
Objective To study the effect of the special surgical position and CO2 pneumoperitoneum on femoral venous hemodynamics during laparoscopic operations. Methods Color Doppler ultrasound was adopted to evaluate the diameter, blood velocity and the amount of the blood flow in the lower extremity of 30 patients undergoing laparoscopy before and after the establishment of pneumoperito- neum with 3 positions （ prostration, feet - down tilt position, and head - down tilt position）. Results Compared with the stage before the pneumoperitoneum, the femoral vein diameter was increased （ P 〈 0.01 ） ,the velocity and the amount of blood flow were decreased （ P 〈 0.01 ） after the establishment of pneumoperitoneum ;Compared with the stage of prostration after the pneumoperitoneum, the femoral vein diameter was increased （ P 〈 0.05 ）, and the velocity and the amount of blood flow decreased （ P 〈 0.05 ） with the feet - down tilt position, and with the head - down tilt position, the femoral vein diameter was decreased （P 〈 0.01 ）, and the velocity and the amount of blood flow increased ,but still less than those before the pneumoperitoneum （ P 〈 0.01, P 〈 0.05 ）. Conclusion The feet - down tilt position and CO2 pneumoperitoneum can interfere with the re - circulation of blood, and increase the risk of deep vein thrombosis after the laparoscopy ; The head - down tilt position is conducive for the blood to re - circulate, which can improve the poor blood returning conducted by CO2 pneumoperitoneum and degrade the risk of deep vein thrombosi4 after the laparoscopy.
出处
《临床外科杂志》
2009年第5期318-319,共2页
Journal of Clinical Surgery
关键词
体位
气腹
下肢深静脉
血流动力学
position
pneumoperitoneum
femoral vein
hemodynamics
