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食管超声多普勒监测腹腔镜胆囊切除术血流动力学的变化(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2003年第6期
页码:
525-527,529
栏目:
临床研究
出版日期:
2003-11-01

文章信息/Info

Title:
Hemodynamic changes during laparoscopic cholecystectomy using transesophageal echo-Doppler
作者:
王强; 陈绍洋; 朱萧玲; 熊利泽; 曾毅; 候丽宏; 胡胜
第四军医大学西京医院麻醉科, 陕西 西安, 710032
Author(s):
WANG Qiang;  CHEN Shao-yang;  ZHU Xiao-ling;  XIONG Li-ze;  ZENG Yi;  HOU LI-hong;  HU Sheng
Deparment of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi 710032, China
关键词:
超声检查;  多普勒; 胆囊切除术;  腹腔镜; 血流动力学
Keywords:
echo-Doppler;  acute hypervolemic hemodilution;  hemodynamics
分类号:
R575.6
DOI:
-
文献标识码:
A
摘要:
目的:应用经食管超声多普勒血流动力学监测仪, 观察腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC) 期间的血流动力学的变化。方法: ASA?～?级择期行LC患者12例为研究对象。麻醉诱导插管后将Hemosonic TM 100 血流动力学监测仪超声探头经口放入食管, 探头置于第三四肋骨间隙(或第五六胸椎间隙) 持续监测心排出量(CO)、每搏量(SV)、心指数(CI)、血流峰速度(PV)、血流加速度(Acc) 和左室射血时间指数(LVETI) ,每隔5 min 输入平均动脉压(MAP) 值后计算体循环血管阻力(SVR) 值。麻醉平稳和各项监测完成后, 于气腹前测定基础值, 然后于气腹即刻、气腹后10、20 和30min 及放气后5 min 作重复测定。手术期间维持气腹压力2kPa 。结果: 研究过程中, SpO2 和PETCO2 维持在正常值范围并保持稳定, ECG 未见心律失常。麻醉后气腹前, 血流动力学各指标维持在正常值范围。气腹后CO , SV , CI, PV , Acc 和LVETI 无显著变化, 而MAP 和SVR 均显著增加(P<0.05) , 但仍属正常范围。结论: ASA I～II 级患者行腹腔镜手术是安全的, 术中血流动力学基本稳定。
Abstract:
AIM: To evaluate the changes of homodynamics during laparoscopic cholecystectomy (LC) in patients using transesophageal echo-Doppler. METHODS: Twelve patients of ASA I～II underging elective LC were included in this study. The anesthetic management was standardized for all patients. After induction of anesthesia and tracheal in tubation, the Hemosonic TM 100 (Arrow In ternational, Reading, PA, USA) transesophageal echo-Doppler probe was placed in the esophagus at the level of T 5～6 vertebra for monitoring cardiac output (CO), stroke volume (SV), cardiac index (CI), peak acceleration (Acc), peak velocity (PV) and left vent ricular ejection time index (LVETI). Mean arterial blood pressure (MAP) were input into the monitor every 5 min to derive total systemic vascular resistance (SVR) values. All patients were subjected to insufflation pressures of 2 kPa. Data were collected at six different time points: before in sufflation, induction of pneumoperitoneum, 10, 20 and 30 minute after in sufflation, and 5 minute after desufflation. RESULTS: SpO2 and PETCO2 did not change significantly during the study. All hemodynamic parameters remained with in the norm al range before in sufflation. There were no changes in CO, SV, C I, PV, A cc and VETI after in sufflation. However, MAP and SVR increased significantly after in sufflation (P<0.05). CONCLUSION: CO2 in sufflation in the abdominal cavity during laparoscopic cholecystectomy does not induce significant hemodynamic changes in cardiopul-monary function in patients of ASA physical status ? or ? .

参考文献/References

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[6] 张钦明, 陈永卫, 侯大为, 等. 腹腔镜手术对心功能影响的动物实验研究 [J] . 中华小儿外科杂志, 2001, 22(6):138-140.

[7] Zuckerman R, Gold M, Jenkins P, et al. The effects of pneumoperitoneum and patient position on hemodynamics during laparoscopic cholecystectomy [J] . Surg Endosc, 2001, 15(6):562-565.

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[10] 王健, 王泉云, 左云霞, 等. 不同麻醉下腹腔镜胆囊切除术对血流动力学的影响 [J] . 中华麻醉学杂志, 1998, 18(8):462-465.

备注/Memo

备注/Memo:
收稿日期：2002-09-19.
更新日期/Last Update: 2003-11-01