腹腔镜胆囊切除术中患者肾血流量的变化  

Changes in renal blood flow during laparoscopic cholecystectomy

作　　者：戴双波[1] 杨平亮[2] 刘斌[3] 齐娟[1] 

机构地区：[1]福建医科大学省立临床医学院 福建省立医院麻醉科,福州市350001 [2]四川大学华西第二医院麻醉科 [3]四川大学华西医院麻醉科

出　　处：《中华麻醉学杂志》2010年第8期916-918,共3页Chinese Journal of Anesthesiology

摘　　要：目的 探讨腹腔镜胆囊切除术中患者肾血流量的变化.方法 择期行腹腔镜胆囊切除术患者32例,年龄18～64岁.气管插管后经口置入食管超声探头,采用经食管超声心动图分别于气腹前（基础状态）、气腹1、5、10、15、20、30 min、气腹停止后1、5 min时测量左肾动脉主干内径、主动脉内径、左肾动脉主干血流速度时间积分和降主动脉血流速度时间积分,计算左肾血流量（LRAF）、降主动脉血流量（DAF）和LRAF与DAF的比值（LRAF/DAF）.分析LRAF和DAF的最大下降时点、最大下降量和最大下降百分比.结果 与基础值比较,气腹中各时点LRAF和DAF下降（P＜0.05）,气腹停止后差异无统计学意义（P＞0.05）;气腹中和气腹停止后各时点LRAF/DAF差异无统计学意义（P＞0.05）.气腹中LRAF和DAF最大下降时间点分别为8.9 min[95%可信区间（95%CI）5.5～12.4 min]和6.7 min（95%CI4.0～9.5 min）,最大下降量分别为130 ml/min（95%CI 96～163 ml/min）和1.57 L/min（95%CI1.20～1.95 L/min）,最大下降百分比分别为40%（95%CI 31%～49%）和38%（95%CI 31%～44%）.结论 腹腔镜胆囊切除术中气腹1～30 min时肾血流量下降,下降的最大程度约40%,时间在气腹9 min左右,其下降的原因与心输出量下降有关.Objective To investigate the changes in renal blood flow during laparoscopic cholecystectomy.Methods Thirty-two ASA Ⅰ patients （10 male, 22 female） aged 18-64 yr, weighing 45-81 kg undergoing laparoscopic cholecystectomy were included in this study. Anesthesia was induced with midazolam, fentanyl,propofol and vecuronium and maintained with isoflurane inhalation, continuous infusion of propofol and remifentanil and intermittent iv boluses of vecuronium. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 30-40 mm Hg. The probe of transesophageal echocardiography （TEE） was inserted into esophagus after tracheal intubation. The internal diameter and blood flow velocity and time integral of left renal artery and descending aorta were measured by TEE before （baseline） and at 1, 5, 10, 15, 20 and 30 min of pneumoperitoneum and 1 and 5 min after deflation. The blood flow of left renal artery （LRAF） and decending aorta （DAF） were calculated. The maximal decrease in LRAF and DAF and LRAF/DAF were analyzed. Results LRAF and DAF decreased significantly during pneumoperitoneum compared to the baseline and recovered after deflation. LRAF and DAF decreased maximally by 40% （95% confidence interval （95% CI） 31%-49% ） and 38% （95% CI 31%-44% ） at 8.9 min （95% CI 5.5-12.4 min） and 6.7 min （95% CI 4.0-9.5 min） of pneumoperitoneum respectively. There was no significant change in LRAF/DAF ratio during pneumoperitoneum. Conclusion The renal blood flow decreases at 1-30 min of pneumoperitoneum with the maximum degree of decrease about 40% at about 9 min of pneumoperitoneum and the reason is related to the decrease in the cardiac output.

关 键 词：胆囊切除术 腹腔镜 肾血流量 

分 类 号：R657.4[医药卫生—外科学]