摘要
目的:通过对腹腔镜胆囊切除术(LC)患者施以经食道超声心动仪HemosonicTM100监测,探讨在不同麻醉方法下CO2气腹对血液动力学影响。方法选择ASAⅠ-Ⅱ级,年龄26～78岁的择期腹腔镜胆囊切除手术的患者36例,麻醉诱导相同,根据麻醉维持方法不同随机分成异丙酚/芬太尼全凭静脉麻醉组(P组)18例和异氟醚吸入组(I组)18例。诱导后置入HemosonicTM100血液动力学监测仪,监测气腹及术毕等各时点的血液动力学指标。结果(1)两组气腹前后的HR未有显著差异,MAP 在气腹后均显著升高。(2)两组气腹后1 min、5 min与气腹前相比,心排量(CO)、主动脉每搏(SVa)、峰速度(PV)下降,体循环阻力(TSVR)明显升高(P<0.05),I组的波动幅度较大,两组气腹期的各时间点比较无显著差异。(3)放气后1 min与气腹前相比,CO、SVa、PV明显升高(P<0.05),而TSVR则显著降低(P<0.05)。(4)气腹期两组血流加速度(Acc)、左室射血时间(LVET)、降主动脉直径(D)变化不明显。结论两种麻醉方法下气腹时血液动力学均发生明显波动,但全凭静脉麻醉对于CO2气腹引起的血液动力学波动幅度较小,且术后恶心、呕吐发生率低、无污染等优点,可供临床借鉴使用。
Objective: Through transesophageal echocardiography HemosonicTM100, to discuss hemodynamic changes induced by pneumoperitoneum under different anesthesia in LC. Methods: Thirty-six patients (ASA I and II), age 26-78 year were divided randomly into two groups: The inhaltion anesthesia (group I) and total intravenous anesthesia (group P). Hemodynamic parameters (HR, MAP, CO, SV, LVET, Acc, PV, TSVR) were measured with transesophageal echocardiography HemosonicTM100 at different times: before insufflation, 1, 5, 10 and 20 min after insufflation, and 1 min after desufflation. Results: (1) In both groups HR did not change significantly, while the SBP, DBP, MAP were significantly increased after NP. (2) SV, CO ,PV in both groups at 1, 5 min after insufflation significantly lower than those before insufflation, while TSVR increased significantly. But there were insignificant between two groups during whole procedures. (3) SV, CO, PV increased significantly at 1 min after desufflation compared with pre-insufflation in both groups, while TSVR decreased significantly. (4) There were no significant changes in LVET?D?Acc in both groups. Conclusions: NP causes significantly hemodynamic changes measured by transesophageal echocardiography HemosonicTM100 in ASA I and II patients but the total in both groups, intrarvenous anesthesia has the advantages of lower hemodynamic changes , less postopertive nausea and vomiting, more comfortable after recovery of consciousness. And lack of air pollution. It is suggested that TIVA is better for laparoscopic surgery.
出处
《中国内镜杂志》
CSCD
2004年第5期47-50,共4页
China Journal of Endoscopy
关键词
麻醉
腹腔镜
胆囊切除术
经食道超声心动仪
血液动力学
anesthesia
laparoscopy
cholecystectomy
transesophageal echocardiography HemosonicTM100
hemodynamics
