FloTrac/Vigileo监测下不同体位腹腔镜手术患者血流动力学的变化  

The effect of the different position on hemodynamic monitored by FloTrac/Vigileo system in patients undergoing laparoscopic appendectomy

作　　者：许常娥 鲍红光[1] 张咏梅 斯妍娜[1] 张勤 孟祥雪[1] 

机构地区：[1]南京医科大学附属南京医院麻醉科,210006 [2]南京市浦口医院 [3]南京市浦口医院麻醉科

出　　处：《临床麻醉学杂志》2014年第12期1169-1171,共3页Journal of Clinical Anesthesiology

摘　　要：目的：探讨 FloTrac／Vigileo 监测下不同体位对腹腔镜阑尾切除术患者血流动力学的影响。方法拟行腹腔镜阑尾切除术患者60例，随机分为三组，每组20例，手术时分别为头低脚高位10°（A 组）、20°（B 组）和30°（C 组）。麻醉前行左桡动脉穿刺连接 FloTrac／Vigileo 系统。记录气腹前（T0）、气腹后1 min（T1）、5 min 稳定后改变体位时（T2）、气腹后20 min（T3）、气腹结束后1 min （T4）及5 min 稳定后恢复体位时（T5）的 HR、MAP、心输出量（CO）、心脏指数（CI）和每搏量（SV），并记录气腹时间和手术时间。结果与 T0时比较，T1～T3时三组 HR 明显增快，MAP 明显升高（P＜0.05）；与 T1时比较，T2、T3时 C 组 CO 及 SV 明显升高（P＜0.05）。与 C 组比较，T2、T3时 A、B 组CO 及 SV 明显降低（P＜0.05）。与 C 组比较，A、B 组气腹时间及手术时间明显延长（P＜0.05）。结论头低脚高位30°下行腹腔镜阑尾切除手术，患者血流动力学的变化在临床安全范围内，且手术时间及气腹时间较10°和20°短。Objective To investigate the effect of the different position on hemodynamic moni-tored by FloTrac/Vigileo system in patients undergoing laparoscopic appendectomy.Methods Sixty patients undergoing laparoscopic appendectomy,ASA Ⅰ or Ⅱ,were randomly divided into three groups （n=20）：group A,B and C underwent the trendelenburg position of 10 degrees,20 degrees and 30 degrees,respectively.HR,MAP,cardiac output （CO）,cardiac index （CI）and stroke volume （SV）were recorded before pneumoperitoneum （T0 ）,1 min after pneumoperitoneum （T1 ）,5 min af-ter trendelenburg position （T2 ）,20 min after pneumoperitoneum （T3 ）,1 min after the end of pneu-moperitoneum （T4 ）and 5 min after the end of trendelenburg position （T5 ）after induction of anesthe-sia.The time of pneumoperitoneum and operation was recorded.Results Compared with T0 ,HR and MAP increased significantly at T1-T3 in three groups（P〈0.05）;Compared with group C,CO and SV decreased significantly at T2-T3 in group A and group B （P〈0.05）.Compared with T1 ,CO and SV increased at T2-T3 in group C （P〈0.05）.Compared with group C,the time of pneumoperitoneum and operation was longer in group A and B （P〈0.05）.Conclusion During the operation of laparo-scopic appendectomy,the change of the hemodynamic is in clinical safe range,and the time of pneu-moperitoneum and operation is shorter in the position of 30°than 10°and 20°in laparoscopic appen-dectomy.

关 键 词：FLOTRAC/VIGILEO 系统 头低脚高位 腹腔镜 血流动力学 

分 类 号：R614[医药卫生—麻醉学]