FloTrac／Vigileo监测不同CO2气腹压对腹腔镜妇科手术患者血流动力学的影响  

Impact of different intra-abdominal pressure on hemodynamic changes monitored by FloTrac/Vigileo in laparoscopic gynecological surgery patients

作　　者：胡建[1,2] 张蕊[1] 鲍红光[1] 陶林[3] 章壮云[3] 韩流[1] 蒋卫清[1] 斯妍娜[1] 

机构地区：[1]南京医科大学附属南京医院南京市第一医院麻醉科,210006 [2]南京溧水县人民医院麻醉科 [3]溧水县人民医院麻醉科

出　　处：《临床麻醉学杂志》2012年第10期981-984,共4页Journal of Clinical Anesthesiology

基　　金：南京市科技局资助项目(201201076)

摘　　要：目的探讨应用FloTrac/Vigileo系统监测CO2气腹下不同腹内压(IAP)对腹腔镜妇科手术患者血流动力学的影响。方法 60例择期行腹腔镜妇科手术患者,按随机数字表法均分为三组:IAP分别为8mmHg(A组)、12mmHg(B组)、15mmHg(C组)。FloTrac/Vigileo系统监测患者血流动力学变化。记录麻醉后5min(T0)、气腹后1min(T1)、气腹后5min改变体位时(T2)、气腹后15min(T3)、气腹结束恢复体位后1min(T4)、5min(T5)时HR、MAP、CVP、外周血管阻力(SVR)和心输出量(CO),记录不良反应的发生情况。结果与T0时比较,T1～T3时三组HR明显增快,MAP和SVR明显升高(P<0.05);T1～T3时A组、T2、T3时B组CVP明显升高(P<0.05);T1～T3时B、C组CO明显降低(P<0.05)。T1～T3时C组的HR明显快于,MAP和SVR明显高于A、B组(P<0.05);T1～T3时B、C组CO明显低于A组,且C组明显低于B组(P<0.05)。C组术中心律失常和术后恶心呕吐的发生率明显高于A、B组(P<0.05)。结论 FloTrac/Vigileo系统监测下的CO2气腹腹内压12mmHg对血流动力学影响较小,适合腹腔镜妇科手术患者。Objective To investigate the impact of different intr〉abdominal pressure （IAP） on hemodynamic changes monitored by FloTrac/Vigileo system in laparoscopic gynecological surgery patients. Methods Sixty patients undergoing laparoscopic gynecological surgery were randomly divided into three groups （n=20） ： group A, B and C underwent a CO2 pneumoperitoneum with IAP 8 mmHg, 12 mmHg or 15 mmHg respectively. The hemodynamic changes were monitored by FloTrac/Vigileo system. HR, MAP, CVP, systemic vascular resistance（SVR）, and cardiac output （CO） were recorded 5 min after anesthesia（T0 ）, 1 min after pneumoperitoneum（Tl ）, 5 min after Trendelenburg position（T2 ）, 15 min after pneumoperitoneum（Ta ）, 1min（T4 ） and 5 min after the end of pneumoperitoneum and Trendelenburg position （T5）. Adverse reactions during the period of operation or after operation were also recorded. Results Compared with To, HR, MAP and SVR increased significantly at T1-T3 in three groups （P〈0. 05）. CVP increased significantly at T1-T3 in group A and T2 ,T3 in group B （P〈0.05）. CO decreased significantly from T1- T3 in group B and C （P〈0.05）. Compared with group A and group B, HR, MAP and SVR increased significantly in group C at T1- T3 （P〈0.05）. CO increased significantly in group A than group C group B at T1-T3 （P〈0.05）. The incidences of arrhythmia and postoperative nausea and vomiting were higher in group C than those in group A and B （P〈0.05）. Conclusion Intra-abdominal 12 mmHg pressure has less effect on FloTrac/Vigileo monitored hemodynamics and is suitable for laparoscopic gynecological surgery patients.

关 键 词：腹腔镜妇科手术 CO2气腹 血流动力学 FloTrac V西1eo系统 

分 类 号：R614[医药卫生—麻醉学]