腹腔镜胆囊切除术CO_2气腹对血流动力学的影响

Hemodvnamic EHects of Carbon Dioxid. InsuHlation of the Peritoneal Cavity for Laparoscopic Cholecystectomy

通过对１０例腹腔镜胆囊切除术患者施以Ｓｗａｎ－Ｇａｎｚ导管监测，探讨ＣＯ２气腹对血流动力学的影响。于ＣＯ２充气前、充气后５ｍｉｎ、２０ｍｉｎ和放气后５ｍｉｎ时，分别测录血流动力学指标。结果表明，ＭＡＰ、ＣＶＰ、ＰＡＰ与ＰＣＷＰ于充气后５ｍｉｎ时，分别增加２８％、１７２％、８３％与１２１％；于充气后２０ｍｉｎ时，分别增加３２％、２０９％、１４７％与１７３％，与充气前相比，变化非常显著（Ｐ＜０．０１）。与充气前相比，ＨＲ与ＰＶＲ于充气后５ｍｉｎ和２０ｍｉｎ时均显著增加（Ｐ＜０．０５），ＳＶＰ、ＣＩ、ＳＩ、ＬＶＳＷＩ与ＲＶＳＷＩ的变化无统计学意义（Ｐ＞０．０５）。结论：ＣＯ２气腹明显增加右心的前后负荷，值得注意。

he hemodynamic effects of insufflation of the peritoneum with carbon dioxide were studied using Swan-Ganzcatheter and thermodilution technique in 10 patients scheduled for laparoscopic cholecystectomy.The hemodynamicparameters were recorded before insufflation,at 5min and20 min after insufflation,and 5 min after exhaust of carbon dioxide respectively。 The results show that MAP,CVP,PAP and PCWP were increasedbv 28%,l 72%,83%and l2l%respectively at 5 min after inxufflation,and by 32%,209%,147%and 173%respectively at 20 min af-ter the insufflation。These changes were statistically significant (P<0.01 ).PVR and HR increased significantly at5min and 20 min after the insufflation(P < 0.05 ).NO significant change in SVR,CI,SL,LVSWl and RVSWIwas found.It is concluded that peritoneal insufflation with carbon dioxide increases the pre-and after-load of theright heart greatly。