vigileo连续监测不同气腹压对腹腔镜胆囊切除术围手术期血流动力学的影响  

Utility of vigileo system in monitoring the impact of pneumoperitoneum pressure on perioperative hemodynamics in patients with laparoscopic cholecystectomy

作　　者：俞南松[1] 牟一平[2] 

机构地区：[1]浙江省绍兴市人民医院肝胆外科,312000 [2]浙江大学医学院附属邵逸夫医院普外科,杭州市310020

出　　处：《中华全科医学》2015年第9期1423-1425,1439,共4页Chinese Journal of General Practice

摘　　要：目的应用vigileo连续监测系统观察不同腹内压下行腹腔镜胆囊切除术患者的血流动力学的变化，探讨vigileo连续监测系统的应用意义及确定适合腹腔镜胆囊切除术患者的最佳气腹压。方法90例腹腔镜胆囊切除术患者，随机分为3组：A组气腹压8mmHg、B组气腹压12mmHg、C组气腹压15mmHg。采用FloTrac／Vigileo系统连续监测患者血流动力学变化。分别记录9个时点的血流动力学指标，包括心率（HR），平均动脉压（MAP）及心输出量（CO），并观察记录手术并发症。结果L时，A，B，C三组患者HR分别为（87．7±10．56）次／min，（93．8±11．54）次／min，（99．1±13．53）次／min，MAP分别为（98．7±12．95）mmHg，（101．5±12．47）mmHg，（116．4±11．73）mmHg，与L时比较，3组患者的HR明显增快，MAP明显增高，以C组的指标变化较为明显（P=0．023）。T6时3组HR及MAP均基本恢复至T0水平；而C组的MAP则在T7时恢复至T0水平；T3和T。时B组CO分别为（3．6±0．73）L／min，（4．8±1．31）L／min，与T0时比较，CO明显降低，且T3时明显低于A组；T3～L时C组的CO分别为（3．6±1．33）L／min，（4．8±1．31）L／min，（3．7±1．06）L／min，明显低于Tn时，且与A组比较差异有统计学意义（P=0．006）。C组出现7例手术并发症，明显高于A、B组。结论采用FloTrac／Vigileo系统可连续方便检测患者围手术期血流动力学参数，且确定12mmHg的腹内压对行腹腔镜胆囊切除术患者的影响较小，较为适宜。Objective FloTrac/vigileo system was conducted to record the perioperative hemodynamic changes under dif- ferent pneumoperltoneum pressure in patients with laparoscopic eholecysteetomy surgery, and the incidence of postopera- tive complications. The aim is to investigate the utility of FloTrac/vigileo system in monitoring the changes of perioperative hemodynamic,and explore a best pneumoperitoneum pressure for laparoseopic eholecystectomy surgery. Methods Ninety patients undergoing laparoscopic cholecystectomy surgery were selected and randomly divided into three groups（ n = 30 cases）, group A, pneumoperitoneum 8 mm Hg（ 1 mm Hg = 0. 133 kPa） ; group B, pneumoperitoneum 12 mm Hg; group C, pneumoperitoneum 15 mm Hg. Hemodynamie parameters [ HR （ Heart rate ）, MAP （ Mean artery pressure ）, CO （ Cardiac output） ] were measured and recorded by FloTrac/vigileo system at 9 selected time points. Results At T3 , the HR values in three groups were （ 87.7 ± 10. 56） beats/min, （93.8 ± 11.54） beats/min and （ 99. 1 ± 13.53 ） beats/min, the MAP values were （98. 7 ± 12. 95）mm Hg, （101.5 ± 12.47） mm Hg and （116. 4±11.73 ） mm Hg. Compared with To, HR and MAP values of T3 - T5 increased significantly. The value of group C was much more obvious and the differences were sta- tistically significant compared with group A and B （P = 0. 023 ）. HR values at T6 of three groups returned to the level of T0. MAP values at T6 of group A and B returned to the level of To, however MAP values at T6 of group C returned to the level of T0. CO values of group B at T3 - T4 are（ 3.6± 0.73 ） L/min and （4. 8 ± 1.31 ） L/min. They were decreased at T3 - T4 compared with To and there was significant difference of T3 with group A （ P 〈 0. 05 ）. CO values of group C at T3 - T5 were （ 3. 6 ± 1.33） L/min, （4. 8± 1.31 ） L/min and （ 3.7 ± 1.06） L/min. They are decreased at T3 - T5 compared with To and there was significant difference of T3 - T5 with group A （ P = 0. 006 ）. T

关 键 词：腹腔镜胆囊切除术 气腹压 血流动力学 FloTrac/Vigileo系统 

分 类 号：R657.4[医药卫生—外科学]