间歇梯度充气加压装置在预防腹腔镜胆囊切除术下肢静脉血液淤滞中的应用

Application of intermittent gradient pneumatic compression devices in prevention of venous stasis in patients undergoing laparoscopic cholecystectomy

目的:探讨腹腔镜胆囊切除术(LC)过程中股静脉血流动力学的变化和使用间歇梯度充气加压装置预防腹腔镜胆囊切除术下肢静脉血液淤滞效果。方法:将腹腔镜胆囊切除术病人随机分成使用间歇梯度充气加压装置组(IPC)和不使用间歇梯度充气加压装置组(NIPC),使用彩色多普勒超声诊断仪分别测定3个不同时期(BL、PP&RT、PO)股静脉流速。结果:NIPC组PP&RT时与BL时比较,股静脉平均血流流速下降69%,差异有显著性(P<0.05)。PO时与BL时比较股静脉平均血流流速差异无显著性(P>0.05)。IPC组PP&RT时与BL时比较,股静脉平均血流流速无明显下降,差异无显著性(P>0.05)。PP&RT时,IPC组与NIPC组比较差异有显著性(P<0.05)。结论:腹腔镜胆囊切除术过程中由于气腹和30°头高脚低体位双重作用股静脉血流缓慢、淤滞。使用间歇梯度充气加压装置可有效预防腹腔镜胆囊切除术静脉血液淤滞。

Objective： To study haemodynamic changes of the femoral vein and the efficacy of intermittent gradient pneumatic compression in prevention of venous stasis in patients undergoing laparoscopic cholecystectumy （LC）. Methods： Patients scheduled for LC were randomly divided into two groups： IPC group using intermittent gradient pneumatic compression device and NIPC group as control. Femoral vein blood velocity was measured using Color Doppler ultrasonic diagnostic apparatus in three different periods （BL, PP＆RT,PO）. Results： In NIPC group, average blood velocity of the femoral vein decreased 69%. Compared with that of BL, there was a significant difference （P〈0.05） in the period of PP＆RT. The average flow velocity of the femoral vein in PO had no significant difference compared with that in BL （P〉0.05）.In IPC group, no significant drop in venous blood velocity and no significant difference （P〉0.05） were found in PP^RT and BL. There was a significant difference in femoral vein blood velocity between NIPC and IPC groups in PP＆RT （P〈0.05）. Conclusion： During laparoscopic cholecystectumy, pneumoperitoneum and reverse Trendlenburg position may decrease femoral velocity. The use of intermittent gradient pneumatic compression device can be effective in preventing laparoscopic cholecystectomy venous stasis.