无创性血流动力学检查在腹腔镜胆囊切除术中的应用

Application of non-invasive haemodynamic assessment in patients undergoing laparoscopic cholecystectomy during perioperative period

目的探讨彩色多普勒超声在腹腔镜胆囊切除术围手术期股静脉血流动力学检测中的作用及意义。方法采用二维灰阶超声、彩色多普勒血流显像及脉冲多普勒超声技术相结合,对28例腹腔镜胆囊切除术患者围手术期及手术期间股静脉横截面积、流速及流量的变化进行测定。结果(1)与术前麻醉状态(BASELINE期)相比,单纯给予气腹(PP期)后,股静脉横截面积由(0.72±0.31)cm2增至(1.08±0.31)cm2(P=0.004),流速由(14.23±11.96)cm/s降至(5.50±2.63)cm/s(P=0.017),流量由(596.49±477.95)ml/min降至(340.41±166.14)ml/min(P=0.018);与PP期相比较,气腹及头高脚低位(PP和RT期)时,股静脉横截面积增大[(1.32±0.14)cm2,P=0.039]、流速降低[(4.40±1.75)cm/s,P=0.034],流量[(346.69±142.66)ml/min,P=0.067]则未见明显降低;与BASELINE期相比,手术后(PO期)股静脉横截面积恢复至术前状态[(0.86±0.15)cm2,P=0.222],股静脉流速[(11.35±8.02)cm/s,P=0.412]、流量[(566.94±348.55)ml/min,P=0.840]也基本得以恢复。(2)彩色多普勒血流结合脉冲多普勒的检测结果显示,28例患者中21例可见股静脉内的血流停滞,其中15例出现返流现象。结论腹腔镜胆囊切除术中由于气腹和头高脚低位体位(reverse Trendelenburg position,RT)的双重作用,股静脉内血流缓慢,甚至会出现短暂的血流停滞、返流等现象,因此,腹腔镜手术围手术期可应用彩色多普勒超声检查以利早期检出下肢深静脉血栓性病变。

Objective To study the role of the color Doppler in patients undergoing laparoscopic cholecystectomy during perioperative period and its significance. Methods The femoral venous crosssectional area, the mean velocity and flow of the femoral vein during four different stages, including baseline, pneumoperitoneum （PP）, pneumoperitoneum and reverse trendlenburg position （PP＆RT）, postoperation （PO）, were measured by using the 2D ultrasound and color Doppler techniques in 28 patients undergoing laparoscopic cholecystectomy. Results （1） Compared with baseline level the femoral venous cross-sectional area increased from （0. 72±0.31）cm^2 to （1.08±0.31）cm^2 （ P =0. 004） during the PP stage, the femoral venous blood velocity declined from （14.23±11.96）cm/s to （5.50±2. 63）cm/s （ P=0.017）, and the femoral venous blood flow decreased from （596.49±477.95）ml/ min to （340.41±166. 14）ml/min （ P=0. 018）. Compared with PP stage, the cross-sectional area [（1.32±0.14）cm^2 , P=0.039] further increased and the velocity decreased [（4.40±1.75）cm/s, P=0. 034]. However, the flow [（346.69±142.66）ml/min, P=0.067] in this stage did not differ from that in PP stage. The femoral venous cross-sectional area [（0. 86±0. 15）cm^2 , P=0. 222] were restored to baseline level in PO ;the velocity [（11.35±8.02）cm/s, P=0.412] and the flow of the femoral vein [（566.94±348. 55）ml/min, P=0. 840] were almost returned to baseline levels. （2） Duplex image of the common femoral vein revealed that the femoral venous stasis occurred in 21 patients, and that of the 21 patients, the femoral venous blood reflux were detected in 15 patients. Conclusions The haemodynamic changes of the femoral vein were caused by the effects of pneumoperitoneum and reverse Trendlenburg position during laparoscopic cholecystectomy, which further reduces femoral velocity and increases the venous stasis, even induce venous blood reflux. These data suggest that the color Doppler technique may be adopted during perioperative periods of laparoscopic procedures for the early detection of deep venous thrombosis.