腹腔镜直肠癌根治术气腹对血流动力学的影响

Influence on hemodynamics during laparoscopic radical resection of rectal cancer

目的：探讨腹腔镜下直肠癌根治术对患者血流动力学的影响。方法：选择美国麻醉协会（ASA）Ⅰ～Ⅱ级腹腔镜直肠癌根治术患者20例（Ⅰ组），并选取同期ASAⅠ～Ⅱ级开腹直肠癌根治术患者20例（Ⅱ组）作为对照组，分别于术中各时段测定有创桡动脉平均动脉压（MAP）、心率（HR）、中心静脉压（CVP），并使用SPSS 11．5统计软件进行比较分析。结果：腹腔镜组HR于气腹后120min与对照组相比明显增快（P〈0．05）。气腹后120min MAP与气腹前和对照组同一时点相比明显升高（P〈0．01），但放气后30min两组MAP比较无明显差异。腹腔镜组气腹后30min，60min，120min CVP明显高于组内气腹前，与对照组各相应时点相比均明显升高（P〈0．01）。结论：腹腔镜下直肠癌根治术对患者血流动力学会产生一定的影响，通过加强术中循环功能的监测和管理，可在术后短时间内恢复近于正常水平。

Objective：To explore the effects on hemodynamics of the patients during laparoscopic radical resection of rectal cancer. Methods：20 patients undergoing elective laparoscopic radical resection of rectal cancer were studied, and 20 patients of rectal cancer treated with laparotomy served as the control group. MAP,HR and CVP were measured at five time points during operation. All data analysis and statistical procedures were carried out with SPSS for Windows 11.5. Results：HR was significantly increased in the laparoscope group compared with that of laparotomy group at 120 minutes after CO2insufflation. MAP were started to heighten at 120 minutes after CO2insufflation. there were significant difference between two groups （P〈0. 01）. while 30 minutes after exsufflation （P〉0. 05）,CVP were significant increased in laparoscope group compared with the laparotomy group after CO2 insufflation （P〈0. 01）. Conclusion： There were adverse effects on hemodynamics of the patients treated with laparoscopic radical resection of rectal cancer. Through emphasizing monitoring and management of hemodynamics in and after surgery, the adverse changes will return to basal level in short time after surgery.