气腹或/和体位因素对腹腔镜手术患者每搏量变异度的影响  

Effect of pneumoperitoneum and/or body position on stroke volume variation in patients undergoing gynecological laparoscopy

作　　者：侯振环 张青林[2] Hou Zhenhuan;Zhang Qinglin(Department of Anesthesiology,Tongzhou District Maternity&Child Health Hospital of Beijing Municipality,Beijing 101199,China;Department of Anesthesiology,Beijing Obsterics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]北京市通州区妇幼保健院麻醉科,北京101199 [2]首都医科大学附属北京妇产医院麻醉科,北京100026

出　　处：《中华麻醉学杂志》2024年第4期454-456,共3页Chinese Journal of Anesthesiology

基　　金：首都医科大学附属北京妇产医院中青年学科骨干培养专项(FCYY201410)。

摘　　要：目的评价腹腔镜手术中二氧化碳气腹或/和体位因素对每搏量变异度(SVV)的影响。方法择期腹腔镜手术患者20例,常规全身麻醉诱导气管插管术后,行机械通气,潮气量8 ml/kg,呼吸频率8~12次/min。维持全身麻醉,于无气腹平卧位(T_(1))、无气腹头低脚高位15°(T_(2))、气腹压(IAP)12 mmHg平卧位(T_(3))、IAP 12 mmHg头低脚高位15°(T_(4))、IAP 15 mmHg平卧位(T_(5))和IAP 15 mmHg头低脚高位15°(T_(6))时,采用Vigileo/FloTrac系统监测每搏量(SV)和SVV。结果与T1时比较,T2时SV和SVV差异无统计学意义(P>0.05);与T_(1)及T_(2)时比较,T_(3-6)时SVV明显升高,SV明显降低(P<0.05);T5与T3时比较及T_(6)与T_(4)时比较,SV差异均无统计学意义(P>0.05),而SVV均明显升高(P<0.05)。结论尽管体位因素对SVV无明显影响,但二氧化碳气腹因素影响较大,提示SVV不适宜评估腹腔镜手术时的容量状态。Objective To evaluate the effect of carbon dioxide pneumoperitoneum and/or body position on stroke volume variation in the patients undergoing gynecological laparoscopy.Methods Twenty patients undergoing gynecological laparoscopy were included in the study.After routine induction of general anesthesia,all the patients were intubated and mechanically ventilated with a tidal volume of 8 ml/kg and a respiratory rate of 8-12 times/min.General anesthesia was maintained.Stroke volume(SV)and stroke volume variation(SVV)were monitored with the FloTrac/Vigileo system at supine position without pneumoperitoneum(T_(1)),15°head-down tilt position without pneumoperitoneum(T_(2)),supine position with pneumoperitoneum pressure(IAP)of 12 mmHg(T_(3)),15°head-down tilt position with IAP 12 mmHg(T_(4)),supine position with IAP of 15 mmHg(T_(5))and 15°head-down tilt position with IAP of 15 mmHg(T_(6)).Results There were no significant differences in SV and SVV between T_(2)and T_(1)(P>0.05).SVV was significantly increased and SV decreased at T3-6 than at T_(1)and T_(2)(P<0.05).There was no significant difference in SV between T_(5)and T_(3)and between T_(6)and T_(4)(P>0.05).SVV was significantly higher at T_(5)than at T_(3)and at T_(6)than at T_(4)(P<0.05).Conclusions Although body position has no significant impact on SVV,the carbon dioxide pneumoperitoneum has a greater influence,indicating that SVV is not suitable for assessing blood volume status during laparoscopic surgery.

关 键 词：每搏输出量 血量 监测 手术中 气腹 人工 体位 

分 类 号：R614[医药卫生—麻醉学]