正反特伦德伦伯格卧位对呼吸循环功能影响

Observation on Influence of Steep Trendelenburg Position on Respiratory and Circulatory Function in 60 Patients

目的观察腹腔镜手术期间正反特伦德伦伯格(Trendelenburg)卧位对患者呼吸循环功能的影响。方法女性腹腔镜胆囊切除术患者30例(A组)术中取反向特伦德伦伯格卧位;女性卵巢囊肿切除术患者30例(B组)术中取特伦德伦伯格卧位,监测气腹前、气腹后、体位改变前、体位改变后15、30 min、术毕气管导管拔除后10 min时的MAP、HR、SpO2、肺胸顺应性(Comp)、气道阻力(Raw)、气道峰压(Ppeak)、PETCO2。结果气腹及体位改变后两组患者MAP、HR、SpO2、Paw、Ppeak、PETCO2明显升高,Comp降低,组内分别与气腹前相比,差异均有统计学意义(P<0.05);组间比较气腹后A组Paw、Ppeak、PETCO2明显高于B组,Comp低于B组,差异均有统计学意义(P<0.05),拔管后B组HR、MAP明显高于A组。结论气腹与体位均使患者循环动力学发生改变,通气功能下降,其中以特伦德伦伯格卧位下降更为明显。

Objective To observe the influence of steep Trendelenburg＇s position on respiratory and circulatory function. Methods Group A consisted of 30 female patients, who were performed celioscopic cholecystectomy under the condition of reverse Trendelenburg＇s position during the operation. Croup B also consisted of 30 female patients, who were performed resection of ovarian cyst under the condition of steep Trendelenburg＇s position during the operation. Some related parameters, such as mean ailway pressure （ MAP）, heart rate （ HR ）, SpO2, pulmonary compliance （ Comp ）, resistance of airway （ RAW ）, peak pressure of airway （Ppeak） and end-tidal CO2 pressure （PETCO2 ）, were monitored before and after pneumoperitoneum, as well as 15 and 30 minutes before and after position ehange. Results Both the groups aehieved signifieant inereases in MAP, HR, SpO2 , RAW, Ppeak and PETCO2 after pneumoperitoneum and position ehange, but Comp was deereased, when intragroup eomparison was done （ P 〈 0.05 ）. RAW, Ppeak and PETCO2 after pneumoperitoneum were signifieantly higher, while Comp was lower in Group A than in Group B （ P 〈 0.05 ）. After extubation （of endotraeheal tube） , MAP and HR of Group B were signifieantly inereased when eompared with that of Group A. Conclusion In addition to ehange in patients＂ hemodynamies, pneumoperitoneum and body position make ventilation deerease, espeeially in steep Trendelenburg＇s position.