腹腔镜术中中心静脉压与相关指标变化的临床意义

Changes of central venous pressure and associated factors during laparoscopic surgery

目的探讨胆囊腹腔镜和妇科腹腔镜手术中中心静脉压（CVP）等指标的变化，并分析手术可能对颅内压（ICP）产生的影响。方法选择ASA Ⅰ-Ⅱ级胆囊及妇科腹腔镜手术患者各20例，分别为胆囊组、妇科组，以丙泊酚及异氟醚、维库溴铵及芬太尼行气管内插管全麻，潮气量（VT）8 ml/kg，呼吸频率（RR）16次/min，术中维持通气条件不变。监测气腹前、气腹与头高位或头低位即刻及气腹后10、20、30 min时CVP、气道峰压（PIP）、平均动脉压（MAP）及呼气末二氧化碳分压（PETCO2）变化。结果胆囊组：气腹后CVP、PIP、MAP无明显变化，PETCO2显著升高（P〈0.001）；妇科组：气腹后CVP、PIP、MAP及PETCO2均显著升高（P〈0.001），CVP与PIP变化呈直线正相关。结论胆囊腹腔镜手术中中心静脉压变化不明显，对颅内压影响较小；妇科腹腔镜手术中中心静脉压明显增高，可能引起颅内压增高。

Objective To investigate the possible influence of central venous pressure and associated factors on intracranial pressure（ICP）during cholecystic and gynecologic laparoscopic surgery. Methods 40 patients（ASA graded Ⅰ-Ⅱ ） undergoing cholecystic（20） and gynecologic（20） laparoscopic surgery were selected. Anesthesia was induced and maintained with propofol, isoflurane and vecuronium bromide. The tidal volume was 8 ml/kg and breathing frequency was 16 times in one minute. The CVP, MAP, peak inspiratory pressure （PIP）and PETCO2 were measured before pneumoperitoneum（PP）, just PP and head up or down,also at 10min, 20min and 30 min after PP respectively. Results In cholecystic group, as compared with those before PP, PETCO2 was increased significantly after PP （P〈0. 001）. In gynecologic group, as compared with those before PP,the CVP,PIP and PETCO2 were increased significantly after PP（P 〈0. 001 ）. A linear correlation existed between CVP and PIP in each group. Conclusion During gynecologic laparoscopic surgery, the ICP may be elevated following the increase of CVP,but the change is not obvious during cholecysfic laparoscopic surgery.