摘要
目的探讨气腹及正反Trendelenburg体位对腹腔镜腹部手术患者血流动力学的影响。方法44例行腹腔镜手术患者被纳入研究。根据手术体位分为A组:反Trendelenberg位(头高30°)。B组:Trendelenberg位(头低30°)。术中所有患者的气腹压力均设为13~15 mmHg,使用Frotrac传感器在各时间点对心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排血量(CO)、体循环阻力(SVR)等数据进行收集。结果气腹即刻可以引起MAP、CVP、SVR升高,HR增快,CO下降;在体位改变后,A组中CVP降低,随后SVR和MAP呈下降趋势,CO和CVP呈上升趋势;B组中MAP,CVP及CO升高,SVR降低,随后SVR、MAP及CVP呈下降趋势,CO呈上升趋势。结论气腹可以引起血流动力学的剧烈波动。Trendelenberg体位可以改善患者在气腹条件下的血流动力学波动,但是对于患有心功能不全的患者,可能增加心血管风险。反Trendelenberg体位对气腹后血流动力学的影响较小。腹腔镜手术可以减轻手术操作时对患者胃肠道的刺激。
Objective To prospectively examine the hemodynamics of pneumoperitoneum and Trendelenburg and reverse Trendelenburg position in the patients undergoing laparoscopic abdominal surgery.Methods Fortyfour patients undergoing laparoscopic surgery were included in the study.According to surgical requirements they were divided into a group A(reverse Trendelenburg position,head up 30°)and a group B(Trendelenburg position,head down 30°).All patients received an abdominal pressure of 13-15 mmHg during operation.The data including heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac output(CO)and systemic circulation resistance(SVR)were collected at various time points using the Frotrac sensor.Results Insufflation caused significant increases in MAP,CVP,SVR and reduction of CO,and slight increase of HR.In the group A,CVP dropped,followed by decreasing trends of SVR and MAP and increasing trends of CO and CVP.In the group B,MAP,CVP and CO of the patients were increased,SVR was decreased,but HR remained unchanged;then CO showed an upward trend,while SVR,MAP and CVP showed downward trends.Conclusions Pneumoperitoneum can cause significant fluctuation of hemodynamic indexes.Trendelenburg position can improve hemodynamic fluctuations in the patients under pneumoperitoneum and reduce adverse effects on the body,however,for the patients with heart failure,the increase in pre-cardiac load may be more detrimental to the patients.Reverse Trendelenburg position nearly does not change the patients’hemodynamics.Laparoscopic surgery can reduce gastrointestinal irritation in the patients during operation.
作者
谭薇
韩园
钱栋臣
郑蒙蒙
齐敦益
Wei Tan;Yuan Han;Dong-chen Qian;Meng-meng Zheng;Dun-yi Qi(School of Anesthesiology,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221006,China)
出处
《中国现代医学杂志》
CAS
2018年第28期89-94,共6页
China Journal of Modern Medicine
