二氧化碳气腹合并头低臀高位对孕妇子宫动脉血流影响的研究  

Study on the effect of carbon dioxide pneumoperitoneum combined with head- low and feet- high position on uterine artery blood flow of pregnant women

作　　者：范保维[1] 黄晓晖[1] 文斌[1] 罗喜平[1] 曾俐琴[1] 陈丹[1] 

机构地区：[1]广东省妇幼保健院妇科,广东广州510010

出　　处：《中国妇幼保健》2015年第6期954-957,共4页Maternal and Child Health Care of China

基　　金：广东省自然科学基金资助〔s2012010010747〕

摘　　要：目的：分析二氧化碳（CO2）气腹合并头低臀高位对妊娠期子宫动脉血流的影响,评估妊娠期腹腔镜的安全性。方法：采用前瞻性研究方法,选取2013年1月~2014年1月在该院行妊娠期腹腔镜手术的20例患者为研究对象,手术开始即进行CO2气腹合并头低臀高位,手术结束后去除CO2气腹及头低臀高位。分别测量术前10 min、手术中及术后15 min双侧子宫动脉搏动指数（PI）、阻力指数（RI）、子宫动脉血流收缩期最大血流速度与舒张末期血流速度的比值（S/D）、收缩期峰值血流速度（PSV）、血p H值、动脉血二氧化碳分压（Pa CO2）、母体心率（MHR）以及胎心率（FHR）,并进行对比研究。结果：术中CO2气腹合并头低臀高位后双侧子宫动脉PI、RI及S/D与术前比较均有所增加,差异均有统计学意义（t=9.33,P〈0.05;t=2.63,P〈0.05;t=10.52,P〈0.05）;双侧子宫动脉PSV与术前比较均有所降低,差异均有统计学意义（左侧：t=93.29,P〈0.05;右侧：t=76.99,P〈0.05）;母体血p H值降低、Pa CO2升高,差异均有统计学意义（t=2.86,P〈0.05;t=4.39,P〈0.05）。术后15 min子宫动脉PI、RI、S/D及PSV与术前10 min比较,差异均无统计学意义（左侧：t=1.72,P〉0.05;t=1.05,P〉0.05;t=1.68,P〉0.05;t=1.84,P〉0.05;右侧：t=1.70,P〉0.05;t=0.89,P〉0.05;t=1.66,P〉0.05;t=1.91,P〉0.05）;母体血p H值和Pa CO2恢复到术前水平,差异均无统计学意义（t=0.87,P〉0.05;t=1.23,P〉0.05）。手术中MHR及FHR较术前10 min有所降低,差异均有统计学意义（t=5.69,P〈0.05;t=5.51,P〈0.05）,术后15 min MHR及FHR仍低于术前10 min MHR及FHR,差异均有统计学意义（t=3.68,P〈0.05;t=7.08,P〈0.05）。结论：妊娠期腹腔镜术中CO2气腹合并头低臀高位可引起双侧子宫动脉血流阻力增加、血供减少、母体血p H值降低、Pa CO2升高,但CO2气腹合并头低臀高位去除后母体双侧子宫动脉血流、母体血p H值和Pa CO2均能迅速恢�Objective: To analyze the effect of carbon dioxide pneumoperitoneum combined with head- low and feet- high position on uterine artery blood flow of pregnant women,evaluate the safety of laparoscopy during pregnancy. Methods: A prospective study was conducted,20 patients receiving laparoscopy during pregnancy in the hospital from January 2013 to January 2014 were selected as study objects,carbon dioxide pneumoperitoneum combined with head- low and feet- high position was adopted during laparoscopy. Pulsatility index( PI),resistance index( RI),the ratio of peak systolic velocity to end diastolic velocity( S/D),peak systolic velocity( PSV),p H value,arterial partial pressure of carbon dioxide( Pa CO2),maternal heart rate( MHR) and fetal heart rate( FHR) of bilateral uterine arteries at 10 minutes before operation,during operation and at 15 minutes after operation were detected,respectively,then the results were compared and researched. Results: PI,RI and S / D of bilateral uterine arteries during operation were statistically significantly higher than those before operation( t = 9. 33,P < 0. 05; t = 2. 63,P < 0. 05; t = 10. 52,P < 0. 05); PSV of bilateral uterine arteries during operation were statistically significantly lower than those before operation( left: t = 93. 29,P < 0. 05; right: t = 76. 99,P < 0. 05); maternal p H value decreased and Pa CO2 increased,there were statistically significant differences( t = 2. 86,P < 0. 05; t = 4. 39,P < 0. 05). There was no statistically significant difference in PI,RI,S / D and PSV between 15 minutes after operation and 10 minutes before operation( left: t = 1. 72,P > 0. 05;t = 1. 05,P > 0. 05; t = 1. 68,P > 0. 05; t = 1. 84,P > 0. 05; right: t = 1. 70,P > 0. 05; t = 0. 89,P > 0. 05; t = 1. 66,P > 0. 05; t =1. 91,P > 0. 05); there was no statistically significant difference in maternal p H value and Pa CO2 between before and after operation( t =0. 87,P > 0. 05; t = 1. 23,P > 0. 05). MHR and FHR during operation were statistically significantly lower than those at 10 minutes

关 键 词：腹腔镜 二氧化碳气腹 体位 妊娠 子宫动脉血流 

分 类 号：R713[医药卫生—妇产科学]