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
侯振环 1张青林2
作者信息
- 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
- 折叠
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(T1)、无气腹头低脚高位15°(T2)、气腹压(IAP)12 mmHg平卧位(T3)、IAP 12 mmHg 头低脚高位 15°(T4)、IAP 15 mmHg 平卧位(T5)和IAP 15 mmHg头低脚高位15°(T6)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T1及T2时比较,T3-6时SVV明显升高,SV明显降低(P＜0.05);T5与T3时比较及T6与T4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.
Abstract
Objective To evaluate the effect of carbon dioxide pneumoperitoneum and/or body po-sition 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 vol-ume variation(SVV)were monitored with the FloTrac/Vigileo system at supine position without pneumoper-itoneum(T,),15° head-down tilt position without pneumoperitoneum(T2),supine position with pneumo-peritoneum pressure(IAP)of 12 mmHg(T3),15° head-down tilt position with IAP 12 mmHg(T4),su-pine position with IAP of 15 mmHg(T5)and 15° head-down tilt position with IAP of 15 mmHg(T6).Re-sults There were no significant differences in SV and SVV between T2 and T,(P＞0.05).SVV was signifi-cantly increased and SV decreased at T3-6 than at T,and T2(P＜0.05).There was no significant difference in SV between T5 and T3 and between T6 and T4(P＞0.05).SVV was significantly higher at T5 than at T3 and at T6 than at T4(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 assess-ing 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Key words
Stroke volume/Blood volume/Monitoring,intraoperative/Pneumoperitoneum,artificial/Posture引用本文复制引用
基金项目
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)
出版年
2024
NETL
NSTL
万方数据