全身麻醉下后腹腔镜手术对循环功能的影响  

Impacts of retroperitoneal laparoscopic surgery under general anesthesia on the circulatory function

作　　者：张利东[1] 王永光[1] 李伟彦[1] 程文[2] 高建平[2] 张征宇[2] 周水根[2] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)麻醉科,江苏南京210002 [2]南京大学医学院临床学院(南京军区南京总医院)泌尿外科,江苏南京210002

出　　处：《医学研究生学报》2007年第12期1268-1270,共3页Journal of Medical Postgraduates

基　　金：江苏省"六大人才高峰"重点课题基金资助项目(批准号:2005A2)

摘　　要：目的：了解后腹腔镜手术对循环功能的影响。方法：选择美国麻醉医师学会（ASA）分级标准Ⅰ～Ⅱ级、择期经后腹腔镜泌尿外科手术患者16例。全身麻醉后观察患者侧卧位前后及气腹前后平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）、平均肺动脉压（MPAP）、肺毛细血管楔压（PCWP）、心脏指数（CI）、混合静脉血氧饱和度（SvO2）、气道峰压（Ppeak）、终末潮气二氧化碳分压（PETCO2）等变化。结果：患者侧卧位前后及气腹前后HR、MAP、SVO2均无显著变化，侧卧位后Ppeak稍有升高，但无统计学意义。而气腹各时间点Ppeak均较气腹前显著增高（P〈0．05），PETCO2于气腹后10min开始显著增高（P〈0．05）并持续于整个气腹期，气腹结束后30minPETCO2，有所下降，但尚未恢复至气腹前水平。CVP、MPAP及PCWP在侧卧位前后无明显变化，但在气腹后各时间点均较气腹前显著增高（P〈0．05）。气腹后CI虽有下降趋势，但无统计学意义。结论：后腹腔镜手术对患者循环功能的影响主要表现为CVP、MPAP、PETCO2及PCWP显著增高，CI有下降趋势，而HR、MAP均无显著变化。Objective ： To investigate the impacts of retroperitoneal laparoscopic surgery on the circulatory function. Methods： We studied 16 patients （ASA Ⅰ - Ⅱ ） undergoing retroperitoneoscopic surgery under general anesthesia and observed their MAP, HR, CVP, MPAP, PCWP, CI, SvO2, Ppeak and PETCO2. Results： There were no significant differences in HR, MAP and SvO2 either before and after lateral decubitus or before and after CO2 insufflation. The Ppeak increased slightly after lateral decubitus but significantly at every time point after CO2 insufflation（ P 〈 0.05 ）. PETCO2 showed a significant increase l0 minutes after CO2 insufflation and remained significantly higher than before, though dropped a little 30 minutes after it. No significant differences were observed in CVP, MPAP and PCWP before and after lateral decubitus, but a significant increase was noted at every time point after C02 insufflation（ P 〈 0.05 ）.CI showed a downtrend after CO2 insufflation, but without statistical significance. Conclusion： Retro- peritoneal laparoscopic surgery impacts the circulatory function by increasing CVP, MPAP, PrTco2 and PCWP and reducing CI after CO2 insufflation, but effects no significant changes in HR, MAP and SvO2.

关 键 词：后腹腔镜手术 侧卧位 CO2气腹 循环功能 

分 类 号：R656[医药卫生—外科学]