腹膜后腔二氧化碳充气对患者血流动力学的影响  

Effects of retroperitoneal carbon dioxide insufflation on hemodynamics

作　　者：周颖[1] 王珊娟[1] 王祥瑞[1] 杭燕南[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,200001

出　　处：《上海医学》2011年第8期577-580,共4页Shanghai Medical Journal

摘　　要：目的探讨泌尿外科腹腔镜手术中腹膜后腔二氧化碳（CO2）充气对患者血流动力学的影响。方法择期在腹腔镜下行肾脏手术的患者42例,采用气管内插管全凭静脉麻醉,连接BioZ.com（连续监测血流动力学变化,分别在气腹前即刻（T0）,气腹后5（T1）、10（T2）、20（T3）、30 min（T4）,停气腹时（T5）,气腹停后5（T6）、10 min（T7）,记录各时间点的心率（HR）、每搏输出量/每搏指数（SV/SI）、平均动脉压（MAP）、心输出量/心脏指数（CO/CI）、体循环血管阻力/阻力指数（SVR/SVRI）、胸腔液体量（TFC）、速率指数（VI）、加速指数（ACI）、预射血期（PEP）、左心室射血时间（LVET）、收缩时间比率（STR=PEP/LVET）、左心做功/做功指数（LCW/LCWI）及呼气末CO2分压（petCO2）,并进行分析。结果腹膜后腔CO2充气前、后,患者的HR、LVET的差异无统计学意义（P值均〉0.05）。与T0时间点比较,T5~T7时间点的CO、CI均显著升高（P值均〈0.05）,T6、T7时间点的SV、SI、VI、ACI均显著升高（P值均〈0.05）,T1~T7时间点的petCO2均显著升高（P值均〈0.05）;T2~T7时间点的MAP均显著降低（P值均〈0.05）,T5~T7时间点的SVR、SVRI、PEP均显著降低（P值均〈0.05）,T3、T4时间点的TFC均显著减少（P值均〈0.05）。与T1~T4时间点比较,T5~T7时间点的SV、SI、CO、CI、VI、ACI均显著升高（P值均〈0.05）,T5~T7时间点的SVR、SVRI、PEP均显著降低（P值均〈0.05）。与T3、T4时间点比较,T5~T7时间点的TFC均显著增加（P值均〈0.05）。与T4时间点比较,T5~T7时间点的LCW、LCWI均显著升高（P值均〈0.05）。结论泌尿外科腹腔镜手术中,腹膜后CO2充气对全身麻醉患者的血流动力学有一定影响,机体有效代偿维持循环稳定,应加强腹膜后腔镜手术围术期麻醉管理。Objective To investigate the influence of retroperitoneal CO2 insufflation on hemodynamics during urological retroperitoneoscopic surgery.Methods Totally 42 patients undergoing elective retroperitoneoscopic urologic surgery were included in the present study,and endotracheal intubation total intravenous anesthesia was used in all patients.The hemodynamic changes were continuously monitored by the Bioz.com system in all patients under general anesthesia.Hemodynamic parameters,including heart rate（HR）,stroke volume（SV）,strock index（SI）,mean arterial pressure（MAP）,cardiac output（CO）,cardiac index（CI）,systemic vascular resistance（SVR）,thoracic fluid content（TFC）,velocity index（VI）,acceleration index（ACI）,pre-ejection period（PEP）,left ventricular ejection time（LVET）,left cardiac work（LCW） and petCO2,were recorded before retroperitoneal insufflation of CO2,at（T0）,5 min（T1）,10 min（T2）,20 min（T3） and 30 min（T4） after retroperitoneal insufflation,and at 0 min（T5）,5 min（T6） and 10 min（T7） after exsufflation.Results No significant changes of HR and LEVT were observed before and after retroperitoneal insufflation of CO2（P0.05）.CO/CI（T5-T7）,SV/SI（T6-T7）,VI（T6-T7）,ACI（T6-T7）,and petCO2（T1-T7） were significantly increased compared with those at T0（P0.05）;and MAP（T2-T7）,SVR/SVRI（T5-T7）,PEP（T5-T7）,and TFC（T3-T4） were significantly decreased than those at T0（P0.05）.SV/SI（T5-T7）,CO/CI（T5-T7）,VI（T5-T7）,and ACI（T5-T7） were significantly elevated and SVR/SVRI（T5-T7）,PEP（T5-T7） were significantly declined compared with those at T1-T4（P0.05）.The TFC（T5-T7） was significantly higher than TFC（T3-T4）（P0.05）;and both LCW and LCWI（T5-T7） were higher than those of T4（P0.05）.Conclusion Rertoperitoneal CO2 insufflation has certain effect on hemodynamics in patients undergoing retroperitoneoscopy under general anesthesia.The vital signs of patients can keep stable with

关 键 词：腹膜后腔镜手术 二氧化碳气腹 阻抗心动图 血流动力学 

分 类 号：R614[医药卫生—麻醉学]