The Hemodynamic Effects of Peritoneal Insufflation during Laparoscopic Operation 柳娟 Juan Liu 医师 岳云 Yun Yue 教授 吴迪 Di Wu 博士研究生 首都医科大学附属北京朝阳医院麻醉科,北京 100020 Department of Anesthesiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing 100020<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /> ABSTRACT Objective: To observe the hemodynamic changes during peritoneal insufflation. Methods: 40 patients ASA 1 or 2, age 20~40 were allocated into two groups: laparoscopic cholecystectomy (n=20) and laparoscopic cystectomy (n=20). The patients were anesthetized with 1.0 MAC enflurane. Hemodynamic parameters were measured with Hemosonic TM100 after the patients were placed to the surgical position, during peritoneal insufflation and at the end of operation. Results: In both groups HR,MAP and CO changed insignificantly after position (P>0.05), HR,MAP,CO,ABF,PV,Sva and TSVR were increased significantly at 1,3,5 and 10min after peritoneal insufflation in both groups. Conclusion: hemodynamics changed significantly during pneumoperitonium. Key Words: Cholecystectomy; Cystectomy; Laparoscopy; Hemodynamics 腹腔镜手术由于其创伤小,恢复快等优点已被广泛应用。但其人工气腹和特殊体位可明显地影响病人的呼吸和循环功能。本研究采用Hemosonic TM100经食道超声心动仪连接观察、比较术中气腹前后血流动力的变化,为腹腔镜手术与麻醉提供临床参考。 资料和方法 1.一般资料 选择ASA I-II级,年龄20~60岁的择期手术病人40例,其中行腹腔镜胆囊切除术的病人20例为I组;行腹腔镜卵巢切除术的病人20例为II组。 2.麻醉方式 入室后静脉给予Scopolamine 0.3mg,Dormincum 0.1mg/kg,并以Fentanly 2μg/kg,Propofol 1.5mg/kg,Norcuron 0.08mg/kg行静脉诱导,气管插管后行机械通气(VT 10mg/kg, f 12bpm,I:E 1:2)异氟醚吸入维持麻醉,持续监测呼末异氟醚浓度在1MAC左右。 3.监测指标 病人入室后用HP监测仪直接监测ABP、HR、SPO2,诱导后将Hemosonic TM100血流动力监测仪探头置入食管深度距门齿约30cm,通过转动手柄进行探头位置的调试,根据血流声音、显示屏的信号及主机的信号质量进行,调节至多普勒降主动脉壁图象清晰,血流波形标准,血流声响亮,然后将测定仪进入测定状态,显示各项参数,并将导管固定。分别于气腹前,头高位后2min(头高45℃),或头低位后2min(头低45℃),气腹后(腹内压1.33Kpa)1、3、5、10、20min及放气后5min连续监测心率(HR)、血压(MAP)、心排量(CO)、主动脉血流量(ABF)、主动脉每搏流量(SVa)、峰速度(PV)、血流加速度(ACC)、主动脉内全身血管阻力(TSVR)及左室射血时间(LVET)等血流动力学指标,观察分析腹腔镜手术时气腹及体位对血流动力学的影响。 4.统计学处理 全部数据用SPSS10.0软件包进行t检验或双因素方差分析。 结果 1.一般资料 两组病人性别、年龄、身高、体重、术前心率、血压均无显著性差异(表1)。 2.血流动力学变化(表2) ①I、II组病人体位前后HR、MAP均未有显著性差异,I组病人体位后(头高45℃)CO比体位前有所减小,但无统计学差异,II组病人CO比体位前有所增加,亦无统计学差异。 ②气腹后1min、5min、10min与气腹前相比,两组病人HR、MAP、CO、ABF、PV、Sva及TSVR均有所增加(P<0.05),以气腹后5min时HR、MAP、CO、ABF、PV、SVa及TSVR增加最为明显(P<0.01)。但I、II组之间并无统计学差异。 ③放气后5min与气腹前相比HR、MAP有所升高(P<0.05),CO、Sva升高明显(P<0.01),而TSVR则显著降低(P<0.01=。组间比较无统计学差异。 |