腹腔镜膀胱癌根治性全切除术中血流动力学的变化  

Hemodynamic changes during laparoscopic radical cystectomy in urinary bladder cancer

作　　者：田丽平[1,2] 陈惠群[1] 雷洪伊[1] 叶小平[1] 曾繁荣[1] 张鸿飞[1] 徐世元[1] 

机构地区：[1]南方医科大学珠江医院麻醉科,广州510280 [2]广东省深圳市第二人民医院麻醉科,518000

出　　处：《广东医学》2016年第1期11-14,共4页Guangdong Medical Journal

基　　金：广东省科技计划项目(编号:2014A020212202)

摘　　要：目的 对腹腔镜膀胱癌根治性全切除术中血流动力学的变化进行全面的监测和分析。方法 选择择期行腹腔镜膀胱癌根治性全切除术成年患者15例,ASAⅠ~Ⅱ级。麻醉诱导前于局麻下经右侧股动脉经皮穿刺置入PiCCOplus热稀释导管,监测前负荷相关指标、心功能相关指标、后负荷相关指标等血流动力学参数。于麻醉诱导前（T1）、气管插管后5min（T2）、气腹及改变体位后5min（T3）、气腹后1h（T4）、开腹后5min（T5）、开腹后1h（T6）及手术结束即刻（T7）采集并分析数据。结果 （1）分别与T1、T2时点比较,中心静脉压（CVP）在T3、T4时点均显著升高（P〈0.01）,T3时点每搏量变异度（SVV）与脉压变异度（PPV）均明显下降（P〈0.05）;与T2时点比较,胸腔内血容积指数（ITBI）在T3时点明显升高（P〈0.05）。（2）与T1时点比较,T2~T6时点心指数均明显降低（P〈0.05）。（3）与T1时点比较,T2时点心率和平均动脉压（MAP）均明显降低（P〈0.05）;与T2时点比较,T3时点心率明显降低（P〈0.05）,T3~T7时点MAP均明显升高（P〈0.05）。结论 腹腔镜全膀胱癌根治性全切除术中血流动力学变化剧烈,ITBI、SVV或PPV较CVP更能准确反映心脏前负荷的变化。Objective To comprehensively monitor and analyze the hemodynamic changes during laparoscopic radical cystectomy in urinary bladder cancer. Methods Fifteen ASA classification of I ~ 11 adult patients with urinary bladder cancer scheduled for elective laparoscopic radical cysteetomy were included in the study . A thermodilution femoral artery catheter was inserted into the fight femoral artery under local anesthesia before induction, to monitor hemodynamic parameters including preload, afterload, cardiac function and heart rate （HR）. Data were collected and analyzed at 7 time points ： before induction of anesthesia （ T1 ） , 5 minutes after intubation （ T2 ） , 5 minutes after pneumoperitoneum and change of posture （ T3 ）, 1 hour after pneumoperitoneum （ T4）, 5 minutes after the abdomen was opened （ T5 ）, 1 hour after the abdomen was opened （T6） and the end of surgery （ T7 ）. Results （ 1 ） Compared with T1 and T2 respectively, central venous pressure（CVP） was significantly higher at T3 and T4 （P 〈 0.01 ）, stroke volume variability（SVV） and pulse pressure variability（PPV） were significantly lower at I3 （P 〈 0. 05 ） ; compared with T2, intrathoracic blood volume index （ITBI） was significantly higher at T3 （ P 〈 0. 05 ）. （2） Compared with T1, cardiac index （CI） was significantly lower at T2 -T6 （P 〈0. 05）. （3） Compared with T1, HR and mean arterial pressure（MAP） were significantly lower at T2 （P 〈 0. 05 ） ; compared with T2, HR was significantly lower at T3 （ P 〈 0. 05 ）, MAP was significantly higher at T3 - T7 （ P 〈 0. 05）. Conclusion Patients undergo dramatic hemodynamie changes during laparoscopie radical cystectomy. ITBI, SVV or PPV may be better indicators than CVP of cardiac preload in this case.

关 键 词：腹腔镜膀胱癌根治性全切除术 血流动力学 前负荷 心功能 后负荷 

分 类 号：R445.1[医药卫生—影像医学与核医学]