不同气腹压条件下腹腔镜胆囊摘除术患者血流动力学的变化  

Effect of different pneumoperitoneum pressure on hemodynamics in laparoscopic cholecystectomy

作　　者：王金保[1] 王姝媛[1] 王琪[1] 张在旺[1] 汤龙信[1] 

机构地区：[1]中国人民解放军白求恩国际和平医院麻醉科,石家庄市050082

出　　处：《临床麻醉学杂志》2012年第2期163-165,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察不同气腹条件下腹腔镜胆囊摘除术患者的血流动力学变化,旨在为腔镜手术探索合适的气腹压力。方法 60例择期行腹腔镜胆囊摘除术患者随机分为Ⅰ组和Ⅱ组,每组30例。Ⅰ组患者术中设定气腹压1.46～1.59kpa,Ⅱ组患者术中设定气腹压为1.06～1.20kpa。采用flotrac/vigileo心排血量监护系统分别观察气腹前(T0)、气腹后10min(T1)、30min(T2)和放气后10min(T3)患者的MAP、HR、PETCO2、心输血量(CO)、心脏指数(CI)、和气道压(Ppeak)等指标。结果 T1、T2时两组患者MAP、PETCO2、Ppeak、CO、CI明显高于、HR明显快于T0时(P<0.05),且Ⅰ组明显高于和快于Ⅱ组(P<0.05)。结论在腹腔镜胆囊摘除术中采用flotrac/vigileo心排血量监护系统监测及时提供可靠依据,提高了腹腔镜手术安全性。Objective To investigate the influence of different pneumoperitoneum pressure on hemodynamics in laparoscopic cholecystectomy （LC） so as to explore appropriate pneurnoperitoneum condition. Methods Sixty patients scheduled for LC were divided into group I and group Ⅱ with 30 cases each. Pneumoperitoneum pressure was set at 1.46-1.59 kpa in group Ⅰ and 1.06-1.20 kpa in group Ⅱ. MAP, HR, PzrCOz, Ppeak, CO and CI were measured and recorded by flotrac/vigileo system at 4 selected time points： before pneumoperitoneum（T0）, 10 min（T1 ）, 30 min（T2） after pneumoperitoneum（T3 ）, closure of the abdominal wall. Results Compared with To, MAP, HR, PzrCOz, Ppeak, CO and CI in group Ⅰ and Ⅱ were increased significantly at T1 ,T2 （P〈0. 05）, while there was more significance in group Ⅰ （P〈0. 05）. Conclusion Flotrac/Vigileo is a timely and reliable method to monitor hemodynamics in LC surgeries with more safety.

关 键 词：Flotrac/Vigileo监护系统 心输出量 腹腔镜 胆囊摘除术 

分 类 号：R657.4[医药卫生—外科学]