机器人手术中体位及气腹对脑的影响及脑保护的研究进展  

Research Advances in the Influence of Trendelenburg Position and Pneumoperitoneum on Brain and Its Protection Strategies during Robotic Surgery

作　　者：赖增燕 何姗姗 陈萍[1] LAI Zengyan;HE Shanshan;CHEN Ping(Department of Anesthesiology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院麻醉科,重庆400016

出　　处：《医学综述》2018年第13期2651-2655,共5页Medical Recapitulate

基　　金：国家临床重点专科建设项目(财社[2011]170号);重庆市医学重点学科建设项目(渝卫科教[2007]2号)

摘　　要：随着微创技术的发展,机器人辅助手术系统凭借其优势在临床应用日趋广泛,其具有创伤小、术野清晰、操作精细等优点。但对于下腹部手术常需采取长时间的Trendelenburg体位和二氧化碳气腹,导致脑静脉回流受阻、血脑屏障功能障碍、脑血管自动调节功能和脑氧供需失衡等,甚至引起脑水肿等,导致患者术后出现严重的神经系统并发症。目前机器人下腹部手术对脑功能的影响机制尚不清楚,且术中的脑保护策略也存在争议,因此根据这些影响因素选择合适的围术期脑保护策略至关重要。With the development of minimally invasive technology,robotic-assisted surgery is becoming increasingly widely used in the clinical application,because it has the advantages of small trauma,clear field view and meticulous operation.Prolonged Trendelenburg position and Carbon Olioxide pneumoperitoneum are usually required during the surgery of the lower abdomen,which may cause cerebral venous obstruction,blood brain barrier dysfunction,cerebrovascular automatic regulation dysfunction and cerebral oxygen supply and demand imbalance,and even cause brain edema,leading to severe neurological complications.At present,the mechanism of the effect of lower abdominal surgery on brain function is not clear,and there is controversy about intraoperative brain protection strategy,which is a great challenge to us.Therefore choosing the appropriate brain protection strategies based on these factors during perioperative period is very important.

关 键 词：机器人手术 Trendelenburg体位 气腹 脑保护 

分 类 号：R614.2[医药卫生—麻醉学]