气腹及体位改变对妇科腹腔镜手术病人应激反应的影响

The stress response to intraoperative pneumoperitoneum and positioning in gynecologic patient over laparoscopy

目的 通过观察妇科腹腔镜手术中气腹及体位改变前后血流动力学和应激反应的变化,探讨腹腔镜手术麻醉中潜在的风险性。方法 20例ASAⅠ-Ⅱ级全麻下行腹腔镜卵巢良性肿瘤切除的病人,分别于术前、气腹前、气腹后、头低位后、恢复体位后、放气后取血5 ml测量激素含量并记录相应时点的血流动力学和呼气末二氧化碳的值。结果 血流动力学指标在气腹和头低脚高体位后与术前比较均有统计学差异(P<0.05)。恢复体位及释放气腹后仍保持较高水平(P<0.05)。呼气末二氧化碳在术中未见明显改变(P>0.05)。各时点激素水平,肾上腺素和去甲肾上腺素在气腹充气后开始升高,但与术前比较无明显差异;而在恢复体位和气腹释放后均明显升高(P<0.05)。皮质醇在气腹和改变体位时均未见明显改变而恢复体位和释放气腹后可见浓度明显升高(P<0.01)。结论 妇科腹腔镜手术气腹充气及头低位后可引起血压升高心率增快,肾上腺素、去甲肾上腺素和皮质醇也会增高,可能是由于多种因素的综合作用所造成。

Objective To investigate the underlying risk of anesthesia in laparoscopy by observing the hemody-namic and stress response during intraoperative pneumoperitoneum and positioning. Methods 20 patients, A-SAⅠ-Ⅱ, underwent laparoscopic ovarian cystectomy. Hemodynamics, end-tidal CO2 and stress hormones were measured at before operation,pre-pneumoperitoneum,post-pneumoperitoneum,post-positioning,resumed position and released pneumoperitoneum. Results Hemodynamics changed significantly after pneumoperitoneum and positioning(P<0.05). The end-tidal CO2 did not change obviously(P>0. 05). Adrenaline,noradrenaline and cortisol increased significantly when pneumoperitoneum released and resumed the position( P < 0.05) ,however, adrenaline and noradrenaline did not increase significantly after pneumoperitoneum which compared with preop-erative values. Conclusion Pneumoperitoneum and positioning can cause hemodynamics and stress hormones increased over laparoscopy.