头低截石位与Trendelenburg位对妇科腹腔镜手术患者心排血量影响的比较  

Comparison of head-down lithotomy position and Trendelenburg position on cardiac output in patients undergoing gynecological laparoscopic surgery

作　　者：沈富毅 宋玉洁 赵青松 李江 刘志强[1] 徐振东[1] SHEN Fu-yi;SONG Yu-jie;ZHAO Qing-song;LI Jiang;LIU Zhi-qiang;XU Zhen-dong(Department of Anaesthesiology,Shanghai First Maternity and Infant Hospital,Shanghai 201204,China)

机构地区：[1]上海市第一妇婴保健院麻醉科,上海201204

出　　处：《复旦学报（医学版）》2020年第2期263-270,共8页Fudan University Journal of Medical Sciences

摘　　要：目的比较头低截石位和Trendelenburg位两种体位对妇科腹腔镜手术患者心排血量(cardiac output,CO)及其他血液动力学参数的影响。方法60例患者分为头低截石位组和Trendelenburg组。患者入室后通过无创心排血量监护仪NICOM系统记录CO基础值。气腹建立后,将患者置于头低30°位(T0),每隔1 min测量心率(heart rate,HR)每搏输出量(stroke volume,SV)和CO等血液动力学参数,共10 min(T1~T10);每隔5 min记录平均动脉压(mean arterial pressure,MAP)和总外周阻力(total peripheral resistance,TPR)。结果将患者置于头低30°位的前6 min内,头低截石位组CO下降幅度显著高于Trendelenburg组(T0:-31%±19%vs.-9%±34%;T1:-32%±18%vs.-16%±38%;T2:-33%±19%vs.-16%±26%;T3:-32%±22%vs.-16%±28%;T4:-31%±18%vs.-12%±38%;T5:-30%±17%vs.-14%±37%;T6:-31%±17%vs.-14%±33%,P均<0.05)。头低截石位组患者的MAP基础值为(97±11)mmHg,显著高于Trendelenburg组的(85±6)mmHg。头低截石位组患者的MAP在T0出现明显下降(-8%±16%),Trendelenburg组患者的MAP在T5和T10显著升高(T5:9%±15%,T10:12%±18%)。结论气腹建立后的最初10 min内,头低截石位患者的CO较Trendelenburg位患者显著下降。Objective To compare the changes in cardiac output(CO)and other hemodynamic parameters in patients undergoing gynecological laparoscopic surgery in head-down lithotomy position and Trendelenburg position.Methods Sixty patients were divided into head-down lithotomy group and Trendelenburg group.CO was recorded as baseline by a noninvasive cardiac output monitor NICOM?system after the placement of patients.These measurements were also acquired when the patients were placed in the 30°head-down tilt(T0)following pneumoperitoneum establishment.Stroke volume(SV),heart rate(HR)and CO were monitored at 1-minute intervals thereafter for a total of 10 minutes(T1-T10),and mean arterial pressure(MAP)and total peripheral resistance(TPR)were monitored every 5 minutes.Results The reduction of CO in head-down lithotomy group was greater than that in Trendelenburg group(T0:-31%±19%vs.-9%±34%;T1:-32%±18%vs.-16%±38%;T2:-33%±19%vs.-16%±26%;T3:-32%±22%vs.-16%±28%;T4:-31%±18%vs.-12%±38%;T5:-30%±17%vs.-14%±37%;T6:-31%±17%vs.-14%±33%,all P<0.05)during the first 6 minutes.MAP at baseline in head-down lithotomy group was significantly higher than that in Trendelenburg group[(97±11)mmHg vs.(85±6)mmHg,P<0.05].MAP decreased in head-down lithotomy group at T0(-8%±16%)and increased in Trendelenburg group at T5 and T10(T5:9%±15%,T10:12%±18%).Conclusion CO reduction was greater in patients in head-down lithotomy position than that in Trendelenburg position group during the first 10 minutes after adjusting the position following pneumoperitoneum establishment.

关 键 词：妇科腹腔镜 心输出量(CO) 头低截石位 Trendelenburg位 

分 类 号：R614[医药卫生—麻醉学] R713[医药卫生—外科学]