不同体位腹腔镜手术对血流动力学、血浆心钠素的影响

Effects of different posture on hemodynamics and plasma atrial natriuretic polypeptide during laparoscopicsurgery

目的观察不同体位腹腔镜手术时血流动力学及血浆心钠素（ANP）的变化，并探讨其临床意义。方法择期腹腔镜手术患者40例，依据术中所需体位分为两组：A组20例，行头低足高体位；B组20例，行头高足低体位。两组麻醉方法相同。分别于气腹前（T1）、气腹压力稳定在14mmHg（1mmHg=0．133kPa）且调整体位后10min（T2）、20min（T3）及解除气腹后5min（T4）监测中心静脉压（CVP）、收缩压（SBP）、舒张压（DBP）及心电图（ECG），同时经中心静脉抽取静脉血，放免法测定血浆中ANP含量。结果A组T2、L时点CVP[（14．45±2．72）、（14．20±2．46）mmHg]和B组T2、L时点CVP[（8．90±1．27）、（9．02±1．47）mmHg]与T1时点[（6．05±1．76）、（6．30±1．34）mmHg]比较明显升高（p〈0．01）；A组．T2、T3时点CVP升高幅度明显高于B组，差异有统计学意义（P〈0．01）。A组ANP在T2时点较T1时点略升高，至B时点显著增高（P〈0．05）。两组间T2、T3时点ANP比较差异有统计学意义（p〈0．05）。结论腹腔镜手术时不同体位对CVP、ANP能够产生明显的影响。

Objective To observe the effects of different posture on hemodynamics and plasma atrial natriuretic polypeptide（ANP） during laparoscopic surgery. Methods Forty patients who scheduled for elective laparoscopic surgery under general anesthesia were allocated into two groups according to their posture during laparoscopic surgery, 20 cases for each group. In group A, the patients were arranged in a head-down tilt position, in group B, the patients were arranged in a head-up tilt position systolic blood pressure （SBP）,diastolic blood pressure （DBP）,central venous pressure （CVP） and electro cardio gram （ECG） were monitored continuously. Blood samples were taken from central venous at four time points of prepneumoperitoneum（T, ）, 10 minutes after that（T2） and 20 mintues （T3） when the patients were arranged at the different operation-needed position with a stable pneumoperitoneum pressure of 14 mm Hg （ 1 mm Hg = 0. 133 kPa ）, and at 5 minutes （T4） after deflation of pneumoperitoneum when the patients returned to supine position. The plasma ANP was assessed by radioimmunoassay. Results In group A, the CVP at T2 and T3 [ （ 14.45 ±2.72 ）, （ 14.20 ± 2.46） mm Hg ] was significantly higher than that at T1 [ （6.05 ±1.76） mm Hg] （P 〈 0.01 ）, in group B, the CVP at T2 and T3[ （ 8.90 ±1.27 ）, （9.02±1.47 ） mm Hg ] was significantly higher than that at T1[ （6.30 ± 1.34） mm Hg]（P〈 0.01 ） ,with a higher level in group A than those in group B at the same time point during pneumoperitoneum（P 〈 0.01 ）. The ANP level in group A was higher at T2 than that at %,and there was significantly higher at T than that at T4 （P 〈0.05）. But the ANP level was ~ignifieantly higher in group A than that in group B at the same time points of T2 and T3 （P 〈 0.05 ）. Conclusion The posture may have obvious effect on CVP and plasma ANP level during laparoscopic surgery.