Trendelenburg体位30°与40°角对腹腔镜直肠癌术野暴露满意度及呼吸、循环功能的影响比较  

Comparison of 30° and 40° angle of Trendelenburg position on satisfaction of operative field exposure and respiratory and circulatory function in laparoscopic radical resection of rectal cancer

作　　者：程先能[1] 彭鲁建[1] 余自君 王丁[1] 张雷[1] 黄大春[1] Chen Xianneng;Peng Lujian;Yu Zijun;Wang Ding;Zhang Lei;Huang Dachun(Department of General Surgery,Chongqing Traditional Chinese Medicine Hospital,Chongqing,400011,China)

机构地区：[1]重庆市中医院普外科,重庆400011

出　　处：《结直肠肛门外科》2018年第4期363-366,共4页Journal of Colorectal & Anal Surgery

摘　　要：目的比较Trendelenburg体位30°与40°角对直肠癌根治术术野暴露满意度及呼吸循环功能的影响。方法将本院82例腹腔镜直肠癌根治术(Dixon术)患者按随机数表法分为观察组与对照组,每组各41例。术中建立CO_2气腹,观察组、对照组Trendelenburg体位角度分别调节至30°、40°。比较两组术野暴露满意度,记录气腹建立时及体位调整后10 min、20 min呼吸循环功能相关指标值,记录两组术后的手术相关呼吸循环系统不良反应发生情况。结果两组总体术野暴露满意度比较,差异无统计学意义(P>0.05)。与建立气腹时相比,两组体位调整后10 min、20 min HR均增快,两组体位调整后20 min HR较调整后10 min增快,观察组体位调整后10 min、20 min HR均慢于对照组,差异均有统计学意义(均P<0.05)。两组间体位调整后10 min MAP差异无统计学意义(P>0.05);两组体位调整后20 min MAP高于调整10 min时,观察组体位调整后20 min MAP高于对照组,差异均有统计学意义(均P<0.05)。建立气腹时,两组PaCO_2、PETCO_2、Ppeak水平差异均无统计学意义(均P>0.05)。观察组体位调整后10 min、20 min各呼吸功能指标值均低于对照组,差异均有统计学意义(均P<0.05)。所有患者术后均未发生低血压、严重低氧血症、心律失常等不良反应。结论直肠癌根治术中Trendelenburg体位调节至30°、40°时术野暴露满意度无差异,前者对呼吸循环功能影响较小。Objective To compare the effects of 30° and 40° angle Trendelenburg position on satisfaction of operative field exposure and respiratory and circulatory function in laparoscopic radical resection of rectal cancer. Methods 82 patients undergoing laparoscopic radical resection of rectal cancer（Dixon surgery） were randomly assigned to treatment group and control group, with 41 patients for each group. The CO_2 pneumoperitoneum was established during the operation. The angle of the Trendelenburg position of the treatment group and the control group was adjusted to 30° and 40°, respectively. The satisfaction of operative field exposure was compared between the two groups. The hemodynamic and respiratory function at the moment of establishment of the pneumoperitoneum and 10 mins and 20 mins after body position adjustment were recorded. The postoperative adverse reactions of respiratory and circulatory system related to operative procedure were compared between the two groups. Results There was no severe insufficiency of operative field exposure. There was no significant difference in the satisfaction of total operative field exposure between the two groups（P〈0.05）. Compared with the moment of establishment of the pneumoperitoneum, HR increased in both groups at 10 mins and 20 mins after body position adjustment and HR was higher at 20 mins than at 10 mins. HR at 10 mins and 20 mins was significantly lower in the treatment group than in the control group（P〈0.05）. The difference in MAP at 10 mins after body position adjustment was not statistically significant between the two groups（P〈0.05）. In both groups, MAP at 20 mins was higher than at 10 mins（P〈0.05）. MAP at 20 mins was higher in the treatment group than in the control group（P〈0.05）. At the moment of establishing pneumoperitoneum, there was no significant difference in the levels of PaCO_2, PETCO_2 and Ppeak between the two groups（P〈0.05）. The respiratory function indices at10 mins and 20 mins after body position adjustme

关 键 词：腹腔镜直肠癌根治术 Trendelenburg体位 调节角度 术野暴露 呼吸循环功能 

分 类 号：R735.3[医药卫生—肿瘤]