摘要
观察腹腔内持续热灌注（ＣＨＰＰ）对胃肠道手术病人呼吸力学、血液动力学及其他生化指标的影响。方法 ＡＳＡⅠ～Ⅱ级择期胃肠道肿瘤手术病人１７ 例，吻合口缝合完毕后进行ＣＨＰＰ。整个手术和热化疗过程中呼吸力学、血液动力学及生化代谢监测。结果 体温：ＣＨＰＰ后血温和颅脑温增高非常明显。ＣＨＰＰ过程中由于颈部局部降温，血温和颅肺温增高相差程度也非常显著（Ｐ＜ ００１）。呼吸：ＣＨＰＰ过程中增高，Ｃｏｍ ｐｌ降低（Ｐ＜ ００１），ＣＨＰＰ结束后恢复正常。ＰＥＴ ＣＯ２ 在ＣＨＰＰ３０ 分钟后开始显著增加。循环：ＣＨＰＰ后ＣＩ由（３３±０９）Ｌ·ｍ ｉｎ－ １ 增高至（４６３±０８）Ｌ·ｍ ｉｎ－ １ ，并维持到手术结束。ＨＲ显著增快，至ＣＨＰＰ结束后又显著下降。ＣＨＰＰ过程中ＭＡＰ显著下降，ＣＨＰＰ结束后恢复到热灌注前水平。ＳＶＲＩ由（１９０３±４４８）降至（１２４６±２５２）ｄｙｎ·ｓ·ｃｍ － ５ ·ｍ － ２（Ｐ＜ ００５），ＳＶＩ无显著变化。ＭＰＡＰ、ＰＡＷＰ、ＣＶＰ均较ＣＨＰＰ前显著增高（Ｐ＜ ００１），ＣＨＰＰ结束即恢复正常。生化代谢：ＣＨＰＰ后ＤＯ２Ｉ、ＶＯ２Ｉ显著增高，ｐＨ、ＢＥ、Ｈｂ 则显著下降（Ｐ＜ ０?
Objective То evaluate the effects of continuous hyperthermic peritoneal perfusion (CHPP) on respiratory,cardiovascular system and biochemical parameters Methods Seventeen ASA grade Ⅰ Ⅱ patients receiving gastric cancer radical resection followed by CHPP were involved in this trial All respiratory,hemodynamic and biochemical parameters were recorded during whole procedures Results The blood temperature (T) blood increased significantly during CHPP,nose T increased only to (37 3±0 9)℃ due to local hypothermia with ice bag around patients neck Respiratory mechanics changed greatly,and P ET CO 2 rose significantly 30 min after CHPP began Cardiac index increased immediately when CHPP began(P<0 01) and was maintained at a high level Heart rate increased during CHPP and return to (91 9±13 8) bpm (P<0 05) when CHPP stopped During CHPP,mean artery pressure and SVRI decreased (P<0 01),meanwhile,MPAP,PAWP and CVP also changed significantly,which returned to normal when CHPP ended DO 2I and VO 2I increased but pH,BE and Hb decreased significantly During CHPP,decrease of SVRI and increase of HR had good relationship with the change of blood temperature (r=-0 981,P<0 01 and r=0 976,P<0 01,respectively) Conclusion The hemodynamic and biochemical changes during CHPP require careful anesthetic monitoring and management to ensure the patients safety
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
1999年第4期206-209,共4页
Chinese Journal of Anesthesiology
关键词
血液动力学
呼吸力学
CHPP
肿瘤
治疗
Hemodynamics Respiratory mechanics Continuous hyperthermic peritoneal perfusion
